Organization
WATERWORKSNOW, INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CYNTHIA GOODMAN M.D. (CEO/PRESIDENT)
67855886767
Entity
Organization
Contact information
Practice address
1525 E PARK PLACE BLVD, SUITE 1800, STONE MOUNTAIN, GA 30087-3453
(678) 558-6767
Mailing address
PO BOX 370354, DECATUR, GA 30037-0354
(678) 558-6767
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
48419
GA
261QM2500X
Medical Specialty Clinic/Center
48419
GA
261QP2000X
Physical Therapy Clinic/Center
48419
GA
261QR1100X
Research Clinic/Center
48419
GA
Other
Enumeration date
04/06/2017
Last updated
04/06/2017
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