Individual
MARISSA WEICHING GOOLSBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4650 HUGH HOWELL RD STE 510, TUCKER, GA 30084-5031
(678) 956-8630
(678) 956-8634
Mailing address
2476 RIDGEFIELD TER, DECATUR, GA 30033-4211
(904) 347-8711
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11151
GA
363AM0700X
Medical Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/14/2019
Last updated
09/11/2024
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