Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 384 | PR |
N | 111NP0017X | Pediatric Chiropractor | CHIRO07391 | GA |
Y | 111NR0400X | Rehabilitation Chiropractor | CHIRO07391 | GA |
NPI | 1376687210 |
---|---|
Provider Name | Dr. Gwyndolyn B. Goodwin |
First Address | Carrollton, GA 30117-3825 |
Second Address | Carrollton, GA 30117-3825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 17/04/2013 |