Provider Demographics
NPI:1225307879
Name:GOODWIN, JAMES W (SA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9715 BURNET RD
Mailing Address - Street 2:#100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5215
Mailing Address - Country:US
Mailing Address - Phone:512-773-4451
Mailing Address - Fax:512-233-5100
Practice Address - Street 1:9715 BURNET RD
Practice Address - Street 2:#100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5215
Practice Address - Country:US
Practice Address - Phone:512-773-4451
Practice Address - Fax:512-233-5100
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11-258246ZS0410X
246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist