# SEASONS MEDICAL AESTHETICS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437340684
- **Authorized official:** NATHAN WAYNE GOODYEAR M.D. (OWNER)
- **Authorized official phone:** (318) 255-3223

## Contact information

- **Practice address:** 411 E VAUGHN AVE, SUITE 201, RUSTON, LA 71270-5972
- **Practice address phone:** (318) 255-3223
- **Practice address fax:** (318) 255-3181
- **Mailing address:** 921 N TRENTON ST, RUSTON, LA 71270-3327
- **Mailing address phone:** (318) 255-3223
- **Mailing address fax:** (318) 255-3181

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 201086 | LA | Yes |

## Other

- **Enumeration date:** 08/05/2007
- **Last updated:** 08/05/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1453331 | — | LA |
| 01 | — | 201086 | MEDICAL LICENSE | LA |
| 01 | — | 5CX71 | MEDICARE | LA |