MR. BRADLEY GORDON GOLDBERG (NPI# 1447348826) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447348826 |
| Entity Type | Individual |
| Full Name | MR. BRADLEY GORDON GOLDBERG |
| Credential | M.D. |
| Practice Address |
2010 Ocilla Rd Douglas GA 31533-2230 |
| Mailing Address |
11 Cross St Hazlehurst GA 31539 |
| Practice Telephone | 9123842500 |
| Practice Fax Number | 9123836788 |
| Mailing Telephone | 9123842500 |
| Mailing Fax Number | 9123836788 |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | 040079 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000741694D | 05 | |
| GA | DEA | BG5301318 | 01 |
| GA | WELLCARE OF GA | 341191 | 01 |
| GA | GA LICENSE | 040079 | 01 |
| GA | BCBS | 700394 | 01 |
| GA | PEACHSTATE | 138903 | 01 |
| GA | MEDICAL LICENSE | 040079 | 01 |
| GA | RAILROAD MEDICARE - GROUP # | DH1281 | 01 |
| GA | CLIA | 11D0941435 | 01 |
| GA | RAILROAD MEDICARE - PTAN | P00726008 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 11 Cross St, Hazlehurst, GA 315396427 | 9123842500 | 9123836788 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740236884 | Bradley Dean Goldberg | Optometrist | 4470 Highland Rd, Waterford, MI 48328-1222 | 2006-05-26 |
| 1477896967 | Bradley Harris Goldberg | Internal Medicine | 300 Community Dr, Manhasset, NY 11030-3816 | 2013-04-03 |
| 1164765244 | Bradley Samuel Goldberg | Emergency Medicine | 4650 W Sunset Blvd # 113, Los Angeles, CA 90027-6062 | 2013-03-27 |
| Street Address |
2010 OCILLA RD |
| City | DOUGLAS |
| State | GA |
| Zip Code | 31533-2230 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932579273 | Hali Varnedore | Nurse Practitioner | 2010 Ocilla Rd, Douglas, GA 31533-2230 | 2015-09-29 |
| 1689042681 | Cathy Herrington | Nurse Practitioner | 2010 Ocilla Rd, Douglas, GA 31533-2230 | 2015-09-08 |
| 1417295601 | Amanda Bice | Nurse Practitioner | 2010 Ocilla Rd, Douglas, GA 31533-2230 | 2013-01-22 |
| 1720338916 | Crh Physician Practices LLC | Clinic/Center | 2010 Ocilla Rd, Douglas, GA 31533-2230 | 2012-09-14 |
| 1073893616 | Justin Peterson | Obstetrics & Gynecology | 2010 Ocilla Rd, Douglas, GA 31533-2230 | 2011-08-26 |
| 1619183340 | Angela Marie Brewer | Nurse Practitioner | 2010 Ocilla Rd, Douglas, GA 31533-2230 | 2007-05-16 |
| 1508938531 | Margaret S. Minchew | Physician Assistant | 2010 Ocilla Rd, Douglas, GA 31533-2230 | 2006-11-14 |
| 1720165947 | Steven Charles Diamond | Obstetrics & Gynecology | 2010 Ocilla Rd, Douglas, GA 31533-2230 | 2006-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508470964 | Swain Drug Company LLC | Pharmacy | 855 Bowens Mill Rd Sw Suite E, Douglas, GA 31533 | 2020-09-03 |
| 1811528649 | Unison Behavioral Health | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 211 North Street, Douglas, GA 31533 | 2020-01-30 |
| 1952940793 | Teresa Smith | Pharmacist | 901 W Ward St, Douglas, GA 31533 | 2019-12-26 |
| 1447641048 | Jennifer Spivey | Nurse Practitioner | 326 Shirley Avenue, Douglas, GA 31533 | 2015-02-18 |
| 1972914497 | Jessica Lynne Courson | Nurse Practitioner | 903 West Ward Street, Suite B, Douglas, GA 31533 | 2014-05-19 |
| 1063840296 | South Central Primary Care Center | Clinic/Center | 303 Shirley Ave, Ste B, Douglas, GA 31533 | 2013-10-25 |
| 1336411008 | Unison Behavioral Health | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 118 Coweta Avenue South, Douglas, GA 31533 | 2012-01-27 |
| 1346482700 | V and V Clinic | Pediatrics | 1020 West Bryan Street, Douglas, GA 31533 | 2009-04-01 |
| 1063650406 | Jayla Snipes Bullock | Speech-Language Pathologist | 618 Bowens Mill Road Sw, Douglas, GA 31533 | 2009-01-22 |
| 1417112707 | Southern Community Services Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 315 S. Gaskin Ave, Douglas, GA 31533 | 2008-07-25 |
| Find all providers in zip 31533 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245628809 | Mahendra G Amin Md PC | Obstetrics & Gynecology | 1022 Bryan St W, Douglas, GA 31533-2328 | 2015-01-06 |
| 1912060401 | Mahendra G Amin | Obstetrics & Gynecology | 1022 West Bryan St, Douglas, GA 31533 | 2006-12-18 |
| 1730177882 | Cheng Hsiung Lin | Obstetrics & Gynecology | 221 Shirley Ave, Douglas, GA 31533-2327 | 2005-10-12 |
| 1770571432 | Mark Steven Campbell | Obstetrics & Gynecology | 111 S 5th St Ste 2, Douglas, WY 82633-2434 | 2005-10-07 |
| 1659622645 | Crh Physician Practices LLC | Obstetrics & Gynecology | 100 Doctors Dr, Ste 202, Douglas, GA 31533-2210 | 2012-10-01 |
| 1629349667 | Douglas Woman's Clinic, P.C. | Obstetrics & Gynecology | 221 Shirley Ave, Douglas, GA 31533-2327 | 2012-01-23 |
| 1073893616 | Justin Peterson | Obstetrics & Gynecology | 2010 Ocilla Rd, Douglas, GA 31533-2230 | 2011-08-26 |
| 1720165947 | Steven Charles Diamond | Obstetrics & Gynecology | 2010 Ocilla Rd, Douglas, GA 31533-2230 | 2006-11-01 |
| 1134183080 | Brian Scott Retherford | Obstetrics & Gynecology | 111 S 5th St, Douglas, WY 82633-2434 | 2006-04-16 |
| 1003817263 | Edward John Miller Jr. | Obstetrics & Gynecology | 100 E 5th St, Douglas, AZ 85607-2859 | 2005-08-09 |
| Find all providers in DOUGLAS | ||||
Please comment or provide details below to improve the information on MR. BRADLEY GORDON GOLDBERG.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.