Individual
BILLY GENE MIMS-GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
5671 PEACHTREE DUNWOODY RD NE, SUITE 680, ATLANTA, GA 30342-5000
(404) 705-6985
(404) 851-9950
Mailing address
PO BOX 740209, DEPT 1029, ATLANTA, GA 30374-0209
(941) 360-1566
(941) 358-9818
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN134535
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000820432
—
GA
Enumeration date
03/21/2006
Last updated
11/18/2010
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