Provider Demographics
NPI:1992780795
Name:GOLDBERG, STEVEN M (PAAA)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:GOLDBERG
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Gender:M
Credentials:PAAA
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Mailing Address - Street 1:3155 N POINT PKWY
Mailing Address - Street 2:ATTN: CREDENTIALING DEPT., BUILDING F, SUITE 100
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-645-9181
Mailing Address - Fax:770-645-8455
Practice Address - Street 1:780 CANTON ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7259
Practice Address - Country:US
Practice Address - Phone:678-574-0943
Practice Address - Fax:678-574-0943
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2008-03-25
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Provider Licenses
StateLicense IDTaxonomies
GA2692367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA32BBBTDMedicare PIN
GAR95127Medicare UPIN