Individual
MR. BRADLEY GORDON GOLDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2010 OCILLA RD, DOUGLAS, GA 31533-2230
(912) 384-2500
(912) 383-6788
Mailing address
11 CROSS ST, HAZLEHURST, GA 31539
(912) 384-2500
(912) 383-6788
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
040079
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000741694D
—
GA
01
—
040079
GA LICENSE
GA
01
—
11D0941435
CLIA
GA
01
—
138903
PEACHSTATE
GA
01
—
341191
WELLCARE OF GA
GA
01
—
700394
BCBS
GA
01
—
DH1281
RAILROAD MEDICARE - GROUP #
GA
01
—
P00726008
RAILROAD MEDICARE - PTAN
GA
Enumeration date
10/10/2006
Last updated
03/07/2023
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