Individual
KENNETH L GOLDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
920 18TH ST, COLUMBUS, GA 31901-1524
(706) 649-6600
(706) 649-6614
Mailing address
920 18TH ST, COLUMBUS, GA 31901-1524
(706) 649-6600
(706) 649-6614
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
014360
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000017586A
—
GA
01
—
20011741
RAILROAD MEDICARE
GA
01
—
2350
BCBS
AL
01
—
52022031-003
BCBS
GA
Enumeration date
02/16/2006
Last updated
01/28/2010
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