Provider Demographics
NPI:1699739359
Name:GOLDBERG, JEFFREY M (PT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4586 TIMBER RIDGE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-7517
Mailing Address - Country:US
Mailing Address - Phone:770-489-3513
Mailing Address - Fax:678-715-5320
Practice Address - Street 1:4586 TIMBER RIDGE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-7517
Practice Address - Country:US
Practice Address - Phone:770-489-3513
Practice Address - Fax:678-715-5320
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0022702251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCCLMedicare ID - Type Unspecified