Organization
GOODWIN MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY DALTON GOODWIN M.D. (OWNER/ SOLE MEMBER OF LLC)
(256) 547-0433
Entity
Organization
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
—
01
—
511-69544
BLUE CROSS BLUE SHIELD LOCATION ID NUMBER
—
Enumeration date
10/27/2015
Last updated
02/24/2016
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