MEDICARE: GERRI BETH GOODMAN PH D

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	103T00000X	Psychologist	PSY002506	GA

General Provider Information

NPI Number	:	1114997608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERRI BETH GOODMAN PH D

Provider Business Mailing Address
First Line	:	2751 BUFORD HWY NE
Second Line	:	DRUID POINTE SUITE 401
City	:	ATLANTA
State	:	GA
Zip	:	30324-3207
Country	:	US
Telephone Number	:	404-639-5556
Fax Number	:	404-639-5558

Provider Business Practice Location Address
First Line	:	2751 BUFORD HWY NE
Second Line	:	DRUID POINTE SUITE 401
City	:	ATLANTA
State	:	GA
Zip	:	30324-3207
Country	:	US
Telephone Number	:	404-639-5556
Fax Number	:	404-639-5558

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	07/08/2007

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