Individual
BRENT THOMAS GOEDJEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
135 NORCROSS ST, ROSWELL, GA 30075-3867
(678) 870-2020
(262) 203-9631
Mailing address
135 NORCROSS ST, ROSWELL, GA 30075-3867
(256) 320-9746
(262) 203-9631
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
73450
GA
207N00000X
Dermatology Physician
ME114104
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009270000
—
FL
Enumeration date
06/10/2011
Last updated
07/22/2022
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