Individual
MARY GOODWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 FREEDOM WAY, AUGUSTA, GA 30904-6258
(321) 356-7689
Mailing address
1213 DERBY LN, GROVETOWN, GA 30813-3835
(321) 356-7689
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
319563
TX
Other
Enumeration date
07/09/2019
Last updated
07/09/2019
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