Provider Demographics
NPI:1043696172
Name:GOODWIN, ELIZABETH (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-1648
Mailing Address - Country:US
Mailing Address - Phone:478-994-1010
Mailing Address - Fax:478-994-1080
Practice Address - Street 1:97 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-1648
Practice Address - Country:US
Practice Address - Phone:478-994-1010
Practice Address - Fax:478-994-1080
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN215448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily