Provider Demographics
NPI:1407816432
Name:GOODMAN, BRAD HENRY (M D)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:HENRY
Last Name:GOODMAN
Suffix:
Gender:
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2668
Mailing Address - Country:US
Mailing Address - Phone:912-354-6190
Mailing Address - Fax:912-354-6172
Practice Address - Street 1:505 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2668
Practice Address - Country:US
Practice Address - Phone:912-354-6190
Practice Address - Fax:912-354-6172
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA38780207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG47700AOtherMEDICARE
GA000762022SMedicaid
GA000762022KMedicaid
GAQ00842796OtherRR MEDICARE
GA000762022RMedicaid