MEDICARE: SUSAN GOLDBY C.R.N.P

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	207V00000X	Obstetrics & Gynecology Physician	1030479	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295794824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN GOLDBY C.R.N.P

Provider Business Mailing Address
First Line	:	1304 13TH AVE SE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-4359
Country	:	US
Telephone Number	:	256-355-9711
Fax Number	:	256-351-9717

Provider Business Practice Location Address
First Line	:	1304 13TH AVE SE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-4359
Country	:	US
Telephone Number	:	256-355-9711
Fax Number	:	256-351-9717

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	02/09/2011

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