Provider Demographics
NPI:1215942875
Name:KENNETH E. GOOLSBY, MD & ASSOCIATES, PC
Entity type:Organization
Organization Name:KENNETH E. GOOLSBY, MD & ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADM.
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-534-8832
Mailing Address - Street 1:200 S ENOTA DR NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3473
Mailing Address - Country:US
Mailing Address - Phone:770-534-8832
Mailing Address - Fax:770-531-7479
Practice Address - Street 1:200 S ENOTA DR NE
Practice Address - Street 2:SUITE 300
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3473
Practice Address - Country:US
Practice Address - Phone:770-534-8832
Practice Address - Fax:770-531-7479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty