Organization
PROVIDENT HEALTH SERVICES, INC.
Active
Other names
Lloyd S. Goodman, MD, P.C.
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR)
(912) 350-9335
Entity
Organization
Contact information
Practice address
4700 WATERS AVE, HEART AND VASCULAR BUILDING, SAVANNAH, GA 31404-6220
(912) 350-8222
(912) 350-8686
Mailing address
PO BOX 933213, ATLANTA, GA 31193-3213
(912) 350-8222
(912) 350-8686
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA3772
RAILROAD MEDICARE GROUP
—
05
—
GPA893
—
SC
Enumeration date
12/12/2006
Last updated
11/12/2007
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