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General NPI Number Information
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NPI Number | 1205174737
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Entity Type | Individual
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Provider Name | JUSTIN R. GOEBEL PA
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Gender | Male
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 104 BURNEY DR
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City | FLOWOOD
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State | MS
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Zip | 39232-6621
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Country | US
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Telephone | 601-987-8200
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Fax | 601-987-8211
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Provider Business Mailing Address
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Address Line | PO BOX 1826
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City | PELHAM
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State | AL
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Zip | 35124-5826
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Country | US
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Telephone | 205-621-3778
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Fax | 205-621-4835
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA00492
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License Number State | MS
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