Healthcare Provider Details

I. General information

NPI: 1548652035
Provider Name (Legal Business Name): KATIE H GOODWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 N POINT PKWY SUITE 207
ALPHARETTA GA
30005-4248
US

IV. Provider business mailing address

3180 N POINT PKWY SUITE 207
ALPHARETTA GA
30005-4248
US

V. Phone/Fax

Practice location:
  • Phone: 770-559-8725
  • Fax: 770-559-8276
Mailing address:
  • Phone: 770-559-8725
  • Fax: 770-559-8276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: