=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235229220
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOODMAN & BROOKS FAMILY PRACTICE ASSOCIATES, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 05/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2820 16TH ST NE
-----------------------------------------------------
City | HICKORY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28601-9600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-304-0840
-----------------------------------------------------
Fax | 828-304-0943
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2820 16TH ST NE
-----------------------------------------------------
City | HICKORY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28601-9600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-304-0840
-----------------------------------------------------
Fax | 828-304-0943
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MRS. LORI LINGLE AUSTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-304-0840
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------