Healthcare Provider Details

I. General information

NPI: 1851823264
Provider Name (Legal Business Name): JENNIFER GOINES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JR DR SE SUITE 310
ATLANTA GA
30303-3049
US

IV. Provider business mailing address

49 JESSE HILL JR DR SE SUITE 310
ATLANTA GA
30303-3049
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-8866
  • Fax:
Mailing address:
  • Phone: 404-251-8866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number85568
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: