Provider Demographics
NPI:1174795298
Name:BRIAN H. GOLDMAN, PH.D., PC
Entity type:Organization
Organization Name:BRIAN H. GOLDMAN, PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:678-485-6143
Mailing Address - Street 1:347 DAHLONEGA ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2406
Mailing Address - Country:US
Mailing Address - Phone:678-495-6143
Mailing Address - Fax:678-455-9496
Practice Address - Street 1:347 DAHLONEGA ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2406
Practice Address - Country:US
Practice Address - Phone:678-495-6143
Practice Address - Fax:678-455-9496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002429103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00895265EMedicaid