Healthcare Provider Details

I. General information

NPI: 1700345469
Provider Name (Legal Business Name): RACHEL M GOODWIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL L MCKINNON

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PRINCETON AVE SW
BIRMINGHAM AL
35211-1303
US

IV. Provider business mailing address

PO BOX 830550 MSC100
BIRMINGHAM AL
35283-0550
US

V. Phone/Fax

Practice location:
  • Phone: 205-977-1949
  • Fax: 205-977-1933
Mailing address:
  • Phone: 800-655-2656
  • Fax: 412-822-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.1438
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: