MEDICARE: HOWARD C GOLDBERG MD

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	174400000X	Specialist	031746	GA
2	208800000X	Urology Physician	31746	GA

General Provider Information

NPI Number	:	1659303808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOWARD C GOLDBERG MD

Provider Business Mailing Address
First Line	:	1930 BRANNAN RD
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-4310
Country	:	US
Telephone Number	:	678-284-4040
Fax Number	:	678-284-4076

Provider Business Practice Location Address
First Line	:	600 PROFESSIONAL DR
Second Line	:	SUITE 120
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30045-7651
Country	:	US
Telephone Number	:	770-963-8444
Fax Number	:	770-963-2261

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	10/17/2019

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