Healthcare Provider Details

I. General information

NPI: 1750465282
Provider Name (Legal Business Name): TONI GOODYKOONTZ, M.D., P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 BUCKHANNON PIKE
NUTTER FORT WV
26301-4410
US

IV. Provider business mailing address

1514 BUCKHANNON PIKE
NUTTER FORT WV
26301-4410
US

V. Phone/Fax

Practice location:
  • Phone: 304-622-8511
  • Fax: 304-622-8542
Mailing address:
  • Phone: 304-622-8511
  • Fax: 304-622-8542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: M GAIL DAVIS
Title or Position: OFFICE MANAGER/PARTNER
Credential:
Phone: 304-622-8511