Active NPI
Stefan Vincent Goldberg, MD
- Pulmonary Disease Physician
- Atlanta, GA
National Provider Identifier
1194337592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- 00024857
- Practice address
- 3239 Bolero Dr
Atlanta, GA 30341-5705 - Phone
- (404) 663-1220
- NPI assigned
- Aug 18, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pulmonary Disease Physician | 207RP1001X | 00024857 | WA | Primary |
Addresses
Primary practice location
3239 Bolero Dr
Atlanta, GA 30341-5705
Mailing address
3239 Bolero Dr
Atlanta, GA 30341-5705
Phone (404) 663-1220
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00024857 | WA | MD | Pulmonary Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597708800000",
"number": "1194337592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3239 BOLERO DR",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303415705",
"telephone_number": "404-663-1220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3239 BOLERO DR",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303415705",
"telephone_number": "404-663-1220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDBERG",
"first_name": "STEFAN",
"middle_name": "VINCENT",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-08-18",
"last_updated": "2020-08-18",
"certification_date": "2020-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "WA",
"license": "00024857",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.