Provider Demographics
NPI:1174705172
Name:GOOD, JOHN LEWIS (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEWIS
Last Name:GOOD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2344
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-2344
Mailing Address - Country:US
Mailing Address - Phone:706-922-0600
Mailing Address - Fax:706-922-0603
Practice Address - Street 1:127 TELFAIR ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2590
Practice Address - Country:US
Practice Address - Phone:706-922-0600
Practice Address - Fax:706-922-0603
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018073L1223G0001X
SC401223G0001X
GADN0138101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA512859848Medicaid
SCZG3810Medicaid