Provider Demographics
NPI:1114605995
Name:GOGGINS, EBONY
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:GOGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 FLORENCE DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4318
Mailing Address - Country:US
Mailing Address - Phone:972-891-0930
Mailing Address - Fax:
Practice Address - Street 1:1002 FLORENCE DR
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4318
Practice Address - Country:US
Practice Address - Phone:972-891-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver