Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | CHIR010369 | GA |
NPI | 1407467996 |
---|---|
Provider Name | Mary Ashley Goodman |
First Address | Suwanee, GA 30024-1491 |
Second Address | Alpharetta, GA 30022-6859 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2020 |
Last Update Date | 28/08/2020 |