MEDICARE: DR. DANIEL S GOODMAN M.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	207R00000X	Internal Medicine Physician	026121	GA

General Provider Information

NPI Number	:	1710901640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL S GOODMAN M.D.

Provider Business Mailing Address
First Line	:	4553 N SHALLOWFORD RD
Second Line	:	SUITE 30-B
City	:	ATLANTA
State	:	GA
Zip	:	30338-6408
Country	:	US
Telephone Number	:	770-455-7082
Fax Number	:	770-455-7087

Provider Business Practice Location Address
First Line	:	4553 N SHALLOWFORD RD
Second Line	:	SUITE 30-B
City	:	ATLANTA
State	:	GA
Zip	:	30338-6408
Country	:	US
Telephone Number	:	770-455-7082
Fax Number	:	770-455-7087

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	01/25/2022

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Directions to “ DR. DANIEL S GOODMAN M.D.” Practice Location

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