Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 065552 | GA |
N | 207Q00000X | Family Doctor | 39544 | KY |
N | 207Q00000X | Family Doctor | 65552 | GA |
NPI | 1003853847 |
---|---|
Provider Name | Dr. Viviana Ines Goldenberg |
First Address | Atlanta, GA 30305-1717 |
Second Address | Fayetteville, GA 30214-7507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 10/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003106664A | (05) | GA |
2691912 | (05) | OH |
64124183 | (05) | KY |