Healthcare Provider Details

I. General information

NPI: 1184679615
Provider Name (Legal Business Name): HARRIET TILLINGHAST GOODRICH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 HWY 9 NORTH SUITE 2
MILL SPRING CA
28756
US

IV. Provider business mailing address

40 POSSUM TROT LN
COLUMBUS NC
28722-9790
US

V. Phone/Fax

Practice location:
  • Phone: 828-894-2016
  • Fax: 828-894-3023
Mailing address:
  • Phone: 828-301-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number101170
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: