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General NPI Number Information
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NPI Number | 1235704172
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Entity Type | Individual
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Provider Name | MARY ANN GOODRICH
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Gender | Female
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Dates
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Enumeration Date | 05/24/2021
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 66 HILL STREET
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City | WOODVILLE
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State | MS
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Zip | 39669
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Country | US
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Telephone | 601-213-7055
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Fax | 601-888-6876
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Provider Business Mailing Address
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Address Line | PO BOX 1594
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City | WOODVILLE
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State | MS
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Zip | 39669-1594
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Country | US
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Telephone | 601-213-7055
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Fax | 601-888-6876
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | 801901868
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License Number State | MS
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