Provider Demographics
NPI:1730602681
Name:GOODNESS, GUY KULUMANU (MSN, BSN, RN, FNP-C)
Entity type:Individual
Prefix:MR
First Name:GUY
Middle Name:KULUMANU
Last Name:GOODNESS
Suffix:
Gender:M
Credentials:MSN, BSN, RN, FNP-C
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Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:824 GI MADDOX PKWY
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-2147
Practice Address - Country:US
Practice Address - Phone:706-695-0561
Practice Address - Fax:706-695-8678
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN241476363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003195877AMedicaid