Healthcare Provider Details

I. General information

NPI: 1275252017
Provider Name (Legal Business Name): MEGAN GOLDSBERRY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MAIN ST STE 300
COLUMBIA SC
29201-3266
US

IV. Provider business mailing address

50 S B B KING BLVD STE 100
MEMPHIS TN
38103-2626
US

V. Phone/Fax

Practice location:
  • Phone: 888-608-0499
  • Fax:
Mailing address:
  • Phone: 901-436-1381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26500
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: