Goedjen, Brent Thomas
Goedjen, Brent Thomas is an individual health care provider with primary practice located at 135 Norcross St , Roswell GA 30075-3867. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Dermatology. Allopathic & Osteopathic Physicians / Dermatology is his primary health care specialty. Goedjen, Brent Thomas can be contacted via phone (678) 870-2020.Contact Information
Primary practice address
135 Norcross St
Roswell GA 30075-3867
Phone: (678) 870-2020
Fax: (262) 203-9631
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | ME114104 | Florida |
Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 73450 | Georgia |
Profile Details
NPI number | 1912292657 |
---|---|
LBN Legal business name | Goedjen, Brent Thomas |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jun 10th, 2011 |
Last updated | Jul 22nd, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1912292657 | NPPES |
Florida | MEDICAID | 009270000 |
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