MEDICARE: GOODWIN COMMUNITY HEALTH CENTER

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1891904579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODWIN COMMUNITY HEALTH CENTER

Provider Business Mailing Address
First Line	:	104 LAKESHORE DR
Second Line	:	STE E
City	:	SAINT MARYS
State	:	GA
Zip	:	31558-3803
Country	:	US
Telephone Number	:	912-554-3559
Fax Number	:	912-554-8344

Provider Business Practice Location Address
First Line	:	3010 HAMPTON AVE
Second Line	:	STE 6
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-4224
Country	:	US
Telephone Number	:	912-466-8909
Fax Number	:	912-466-8995

Authorized Official
Title or Position	:	CEO
Name	:	PATRICIA J KOTA
Credential	:	RN, MSPL
Telephone Number	:	912-554-3559

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/22/2020

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Directions to “GOODWIN COMMUNITY HEALTH CENTER ” Practice Location

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