Individual
GOLDA KWAYISI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1404 RIVER PL STE 201, BRASELTON, GA 30517-5600
(770) 219-9200
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
82956
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G12535A
—
GA
Enumeration date
04/10/2014
Last updated
11/14/2022
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