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General NPI Number Information
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NPI Number | 1013956663
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Entity Type | Individual
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Provider Name | JAMIE C GOODMAN DO
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 6119 WHITE HORSE RD STE 14
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City | GREENVILLE
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State | SC
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Zip | 29611-3838
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Country | US
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Telephone | 864-614-7001
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 740013
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City | ATLANTA
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State | GA
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Zip | 30374-0013
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Country | US
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Telephone | 312-733-9730
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO1433
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102201965
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 37735
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License Number State | SC
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