# JEFFREY E GOLDBERG, MD, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Children's ENT Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114103595
- **Authorized official:** DR. JEFFREY E GOLDBERG MD (OWNER)
- **Authorized official phone:** (770) 495-3820

## Contact information

- **Practice address:** 4245 JOHNS CREEK PARKWAY, SUITE D, SUWANEE, GA 30024
- **Practice address phone:** (770) 495-3820
- **Practice address fax:** (770) 495-3820
- **Mailing address:** 4245 JOHNS CREEK PARKWAY, SUITE D, SUWANEE, GA 30024
- **Mailing address phone:** (770) 495-3820
- **Mailing address fax:** (770) 495-3820

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 036754 | GA | Yes |

## Other

- **Enumeration date:** 01/15/2008
- **Last updated:** 09/02/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000630594B | — | GA |