Healthcare Provider Details

I. General information

NPI: 1801329461
Provider Name (Legal Business Name): TIMOTHY GOOLDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BALDWIN AVE
CHARLOTTE NC
28204-3109
US

IV. Provider business mailing address

225 BALDWIN AVE
CHARLOTTE NC
28204-3109
US

V. Phone/Fax

Practice location:
  • Phone: 704-376-1605
  • Fax:
Mailing address:
  • Phone: 704-376-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2025-02394
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: