MEDICARE: REGINALD E GOLDSBY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1184692915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGINALD E GOLDSBY

Provider Business Mailing Address
First Line	:	309 WALNUT ST
Second Line	:	STE D
City	:	AMITE
State	:	LA
Zip	:	70422
Country	:	US
Telephone Number	:	985-748-9030
Fax Number	:	985-748-5352

Provider Business Practice Location Address
First Line	:	309 WALNUT ST
Second Line	:	STE D
City	:	AMITE
State	:	LA
Zip	:	70422
Country	:	US
Telephone Number	:	985-748-9030
Fax Number	:	985-748-5352

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JULIA A SUMRALL
Credential	:
Telephone Number	:	985-748-9030

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	10/31/2007

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Directions to “REGINALD E GOLDSBY ” Practice Location

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