Healthcare Provider Details

I. General information

NPI: 1104908144
Provider Name (Legal Business Name): BRENDA B GOOLSBY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 N. PEACHTREE STREET
LINCOLNTON GA
30817
US

IV. Provider business mailing address

72 KELLY ST
LINCOLNTON GA
30817-2800
US

V. Phone/Fax

Practice location:
  • Phone: 706-359-3154
  • Fax: 706-359-1939
Mailing address:
  • Phone: 706-359-1196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN054204
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: