MEDICARE: CAZ GOODMAN, D.C., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIR008024	GA

General Provider Information

NPI Number	:	1053521476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAZ GOODMAN, D.C., P.A.

Provider Business Mailing Address
First Line	:	3370 SUGARLOAF PKWY
Second Line	:	SUITE G7
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-5478
Country	:	US
Telephone Number	:	678-225-5553
Fax Number	:	678-225-5554

Provider Business Practice Location Address
First Line	:	3370 SUGARLOAF PKWY
Second Line	:	SUITE G7
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-5478
Country	:	US
Telephone Number	:	678-225-5553
Fax Number	:	678-225-5554

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CAZ GOODMAN
Credential	:	D.C.
Telephone Number	:	678-225-5553

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/22/2020

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