Provider Demographics
NPI:1033183462
Name:GOODWIN, BRENDA (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-0763
Mailing Address - Country:US
Mailing Address - Phone:423-290-8978
Mailing Address - Fax:423-760-3882
Practice Address - Street 1:5616 BRAINERD RD STE 208
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5376
Practice Address - Country:US
Practice Address - Phone:423-265-3561
Practice Address - Fax:423-265-1364
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30786207RE0101X
AK178594207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
H12839Medicare UPIN
TN3882092Medicare ID - Type Unspecified