Provider Demographics
NPI:1265834907
Name:GOUDY-MCWILLIAMS, DAMITA
Entity Type:Individual
Prefix:
First Name:DAMITA
Middle Name:
Last Name:GOUDY-MCWILLIAMS
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 1:1633 KARON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1250
Mailing Address - Country:US
Mailing Address - Phone:614-725-0356
Mailing Address - Fax:
Practice Address - Street 1:1633 KARON DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1250
Practice Address - Country:US
Practice Address - Phone:614-725-0356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide