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General NPI Number Information
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NPI Number | 1568653186
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Entity Type | Individual
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Provider Name | JACEY ELIZABETH GOODWIN DMD
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Gender | Female
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 4850 HIGHWAY 19 S
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City | ZEBULON
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State | GA
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Zip | 30295-3486
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Country | US
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Telephone | 404-617-9695
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 520
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City | MILNER
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State | GA
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Zip | 30257-0520
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Country | US
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Telephone | 404-617-9695
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN013095
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License Number State | GA
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