Provider Demographics
NPI:1184679615
Name:GOODRICH, HARRIET TILLINGHAST (PA)
Entity Type:Individual
Prefix:
First Name:HARRIET
Middle Name:TILLINGHAST
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 POSSUM TROT LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-9790
Mailing Address - Country:US
Mailing Address - Phone:828-301-3318
Mailing Address - Fax:
Practice Address - Street 1:82 HWY 9 NORTH
Practice Address - Street 2:SUITE 2
Practice Address - City:MILL SPRING
Practice Address - State:CA
Practice Address - Zip Code:28756
Practice Address - Country:US
Practice Address - Phone:828-894-2016
Practice Address - Fax:828-894-3023
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101170363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCR30010Medicare UPIN