Healthcare Provider Details

I. General information

NPI: 1952357949
Provider Name (Legal Business Name): THOMAS C GOODWIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 SOUTHSIDE AVENUE SUITE 300
ASHEVILLE NC
28801-4100
US

IV. Provider business mailing address

90 SOUTHSIDE AVENUE SUITE 300
ASHEVILLE NC
28801-4100
US

V. Phone/Fax

Practice location:
  • Phone: 828-210-2048
  • Fax: 828-277-4847
Mailing address:
  • Phone: 828-210-2048
  • Fax: 828-277-4847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number27915
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: