Provider Demographics
NPI:1225033442
Name:GOODLET, JAMES S JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:GOODLET
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:185 BLAIR VALLEY DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8033
Mailing Address - Country:US
Mailing Address - Phone:770-880-5372
Mailing Address - Fax:
Practice Address - Street 1:185 BLAIR VALLEY DR NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8033
Practice Address - Country:US
Practice Address - Phone:770-880-5372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND11080208800000X
ME11769208800000X
GA17808208800000X
MT11769208800000X
AL23959208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology