Individual
JEREMY DALTON GOODWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
431 S 3RD ST, GADSDEN, AL 35901-5210
(256) 547-0433
(256) 547-0460
Mailing address
431 S 3RD ST, GADSDEN, AL 35901-5210
(256) 547-0433
(256) 547-0460
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24747
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10270G2201
MEDICARE GROUP PTAN
AL
01
—
102I082199
MEDICARE PTAN
AL
01
—
511-69544
BLUE CROSS BLUE SHIELD LOCATION ID NUMBER
AL
Enumeration date
03/25/2006
Last updated
01/18/2016
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