Individual
DR. JACOB GOATLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
135 CANNON ST STE 405, CHARLESTON, SC 29425-3800
(843) 792-2575
Mailing address
169 ASHLEY AVE RM 202, CHARLESTON, SC 29425-8905
(843) 792-2575
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
57.249415
OH
390200000X
Student in an Organized Health Care Education/Training Program
57.249415
OH
Other
Enumeration date
06/03/2020
Last updated
04/25/2024
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