Provider Demographics
NPI:1053521476
Name:CAZ GOODMAN, D.C., P.A.
Entity type:Organization
Organization Name:CAZ GOODMAN, D.C., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-225-5553
Mailing Address - Street 1:3370 SUGARLOAF PKWY
Mailing Address - Street 2:SUITE G7
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5478
Mailing Address - Country:US
Mailing Address - Phone:678-225-5553
Mailing Address - Fax:678-225-5554
Practice Address - Street 1:3370 SUGARLOAF PKWY
Practice Address - Street 2:SUITE G7
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-5478
Practice Address - Country:US
Practice Address - Phone:678-225-5553
Practice Address - Fax:678-225-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty