Individual
JAMIE C GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6119 WHITE HORSE RD STE 14, GREENVILLE, SC 29611-3838
(864) 614-7001
Mailing address
PO BOX 740013, ATLANTA, GA 30374-0013
(312) 733-9730
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0102201965
VA
207Q00000X
Family Medicine Physician
Primary
37735
SC
207Q00000X
Family Medicine Physician
DO1433
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013956663
—
VA
05
—
3300102
—
TN
05
—
3300103
—
TN
05
—
3300104
—
TN
05
—
377355
—
SC
01
—
4134193
BLUE CROSS
TN
01
—
4149923
BLUE CROSS
TN
01
—
P00357325
RAILROAD MEDICARE
TN
Enumeration date
06/06/2006
Last updated
11/28/2023
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