Individual
ANDREA D. GOODWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4715 24TH PL, MERIDIAN, MS 39305
(601) 696-6736
(601) 696-6778
Mailing address
4715 24TH PL, MERIDIAN, MS 39305-1686
(601) 696-6736
(601) 696-6778
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
17693
MS
207QB0002X
Obesity Medicine (Family Medicine) Physician
Primary
17693
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00755091
—
MS
01
—
P00071956
RAILROAD MEDICARE
—
Enumeration date
11/18/2005
Last updated
07/21/2022
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