NPIMap

Organization Active NPI

Goodman Dermatology, PC

  • Dermatology Physician
  • Roswell, GA
National Provider Identifier
1770801144
Registry record updated Mar 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
064221 Issued in GA
Legal business name
GOODMAN DERMATOLOGY, PC
Practice address
2500 Hospital Blvd Ste 280
Roswell, GA 30076-4918
Phone
(770) 754-0787
Fax
(770) 755-5890
NPI assigned
May 11, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marcus Goodman, D.O.NPI 1407075880
Title
Owner
Phone
(770) 754-0787

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 064221 GA Primary

Addresses

Primary practice location

2500 Hospital Blvd Ste 280
Roswell, GA 30076-4918

Mailing address

2500 Hospital Blvd Ste 280
Roswell, GA 30076-4918
Phone (770) 754-0787

Other practice location 1

1163 Johnson Ferry Rd Ste 250
Marietta, GA 30068-2797
Phone (770) 754-0787

Other practice location 2

2001 Professional Pkwy Ste 250
Woodstock, GA 30188-6445
Phone (770) 754-0787

Other practice location 3

5983 Highway 53 E Ste 200
Dawsonville, GA 30534-6293
Phone (770) 754-0787

Other practice location 4

470 Northside Cherokee Blvd Ste 170
Canton, GA 30115-8029
Phone (770) 754-0787

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mgoodman@directaddress.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100720000586 GA Part B Supplier - Clinic/Group Practice 7810029246 Receives reassigned benefits from 20 practitioners
Practice locations: Buford, GA; Canton, GA; Cumming, GA; Dawsonville, GA; Marietta, GA; Roswell, GA; Smyrna, GA; Woodstock, GA…

National Provider Directory

National Provider Directory

Locations

4298 Atlanta Rd SE
#320
Smyrna, GA 30080
Phone (470) 242-0717

117 Towne Lake Pkwy
Ste 320
Woodstock, GA 30188
Phone (770) 754-0787

Interoperability endpoints

  • Direct secure messaging: mgoodman@directaddress.net

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648080000000",
    "number": "1770801144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 HOSPITAL BLVD STE 280",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764918",
            "telephone_number": "770-754-0787",
            "fax_number": "770-755-5890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 HOSPITAL BLVD STE 280",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764918",
            "telephone_number": "770-754-0787",
            "fax_number": "770-755-5890"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1163 Johnson Ferry Rd Ste 250",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300682797",
            "country_code": "US",
            "telephone_number": "770-754-0787",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2001 Professional Pkwy Ste 250",
            "address_purpose": "LOCATION",
            "city": "Woodstock",
            "state": "GA",
            "postal_code": "301886445",
            "country_code": "US",
            "telephone_number": "770-754-0787",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5983 Highway 53 E Ste 200",
            "address_purpose": "LOCATION",
            "city": "Dawsonville",
            "state": "GA",
            "postal_code": "305346293",
            "country_code": "US",
            "telephone_number": "770-754-0787",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "470 Northside Cherokee Blvd Ste 170",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "GA",
            "postal_code": "301158029",
            "country_code": "US",
            "telephone_number": "770-754-0787",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GOODMAN DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-11",
        "last_updated": "2022-03-24",
        "certification_date": "2022-03-24",
        "status": "A",
        "authorized_official_last_name": "GOODMAN",
        "authorized_official_first_name": "MARCUS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-754-0787",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "GA",
            "license": "064221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mgoodman@directaddress.net",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2500 Hospital Blvd Ste 280",
            "city": "Roswell",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300764918",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.