Individual
MRS. AMANDA GOODWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
4400 WALNUT ST, GREENVILLE, TX 75401-5586
(903) 455-4618
Mailing address
250 RAVINE ST, EMORY, TX 75440-2433
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
214317
TX
Other
Enumeration date
10/01/2018
Last updated
10/01/2018
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