Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2449 | GA |
NPI | 1437365616 |
---|---|
Provider Name | Dr. Paul Aaron Goldberg |
First Address | Kennesaw, GA 30152-2438 |
Second Address | Marietta, GA 30067-8644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 08/07/2007 |