Healthcare Provider Details

I. General information

NPI: 1881396240
Provider Name (Legal Business Name): COLIN GOAD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 NASHVILLE RD
BOWLING GREEN KY
42101-4000
US

IV. Provider business mailing address

1225 FAIRWAY ST FL 2
BOWLING GREEN KY
42103-2477
US

V. Phone/Fax

Practice location:
  • Phone: 270-781-5111
  • Fax:
Mailing address:
  • Phone: 270-780-2497
  • Fax: 270-783-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number06316
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: