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General NPI Number Information
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NPI Number | 1912188749
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Entity Type | Organization
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Legal Business Name | G. SUZANNE GOODCHILD D.O., P.A.
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 2200 JAMES RD
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City | GRANBURY
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State | TX
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Zip | 76049-8207
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Country | US
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Telephone | 817-326-2727
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Fax | 817-326-5737
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Provider Business Mailing Address
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Address Line | 2200 JAMES RD
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City | GRANBURY
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State | TX
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Zip | 76049-8207
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Country | US
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Telephone | 817-326-2727
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Fax | 817-326-5737
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Authorized Official
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Title or Position | OWNER
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Name | GINGER SUZANNE GOODCHILD
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Credential | D.O.
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Telephone | 817-326-2727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | L1867
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License Number State | TX
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