MEDICARE: MRS. RHONDA LYNN GOINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1174766760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RHONDA LYNN GOINS

Provider Business Mailing Address
First Line	:	1805 DALLAS DR
Second Line	:
City	:	TIFTON
State	:	GA
Zip	:	31794-9535
Country	:	US
Telephone Number	:	229-326-2268
Fax Number	:

Provider Business Practice Location Address
First Line	:	1805 DALLAS DR
Second Line	:
City	:	TIFTON
State	:	GA
Zip	:	31794-9535
Country	:	US
Telephone Number	:	229-326-2268
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2009
Last Update Date	:	04/12/2009

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