Healthcare Provider Details

I. General information

NPI: 1669454948
Provider Name (Legal Business Name): TIMOTHY B GOODWIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 AIRPORT BLVD
MOBILE AL
36608-3709
US

IV. Provider business mailing address

PO BOX 851897
MOBILE AL
36685-1897
US

V. Phone/Fax

Practice location:
  • Phone: 800-476-8646
  • Fax: 919-382-3210
Mailing address:
  • Phone: 800-476-8646
  • Fax: 919-382-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number16345
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: