=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750689485
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MALIKA B. GOODEN DC, MPH, CMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2011
-----------------------------------------------------
Last Update Date | 03/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2125 HILLTOP OVERLOOK WAY
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30062-2915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-513-3490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 519 JOHNSON FERRY RD BLDG B - SUITE 350
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30068-4641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-693-2247
-----------------------------------------------------
Fax | 770-693-2432
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR008248
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------