Healthcare Provider Details

I. General information

NPI: 1083048052
Provider Name (Legal Business Name): AMANDA J GOODWIN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 CLIFTWOOD DR SUITE C
ATLANTA GA
30328-4917
US

IV. Provider business mailing address

95 CLIFTWOOD DR SUITE C
ATLANTA GA
30328-4917
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-0188
  • Fax: 404-257-9054
Mailing address:
  • Phone: 404-257-0188
  • Fax: 404-257-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR009251
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: