Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 22230 | GA |
NPI | 1003302852 |
---|---|
Provider Name | Louis Wayne Goolsby |
First Address | Macon, GA 31216-5641 |
Second Address | Macon, GA 31216-6031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2018 |
Last Update Date | 05/07/2018 |