Healthcare Provider Details

I. General information

NPI: 1720598683
Provider Name (Legal Business Name): DAVID O GOODWIN CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 US HIGHWAY 431 STE 34
ALBERTVILLE AL
35950-2083
US

IV. Provider business mailing address

5850 US HIGHWAY 431 STE 34
ALBERTVILLE AL
35950-2083
US

V. Phone/Fax

Practice location:
  • Phone: 866-607-2869
  • Fax:
Mailing address:
  • Phone: 866-607-2869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-144033
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: