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Individual
DR. GLENN LEE GOODHART
Active
Individual
DR. GLENN LEE GOODHART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
D29594
GA
207R00000X
Internal Medicine Physician
19386
GA
207R00000X
Internal Medicine Physician
Primary
MD-43462
IA
207R00000X
Internal Medicine Physician
ME116577
FL
208M00000X
Hospitalist Physician
MD034685L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00213694A
—
GA
01
—
019386
LICENSE NUMBER
GA
01
—
2027755
AETNA US GROUP NUMBER
GA
01
—
52241370
BCBS PROVIDER NUMBER
GA
01
—
85001797G
GEORGIA BETTER HEALTHCARE
GA
01
—
854101
CIGNA ID NUMBER
GA
01
—
9206456
UNITED HEALTHCARE ID
GA
Enumeration date
07/19/2006
Last updated
03/07/2023
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