Provider Demographics
NPI:1275179020
Name:GEORGETOWN PEDIATRICS, PSC
Entity Type:Organization
Organization Name:GEORGETOWN PEDIATRICS, PSC
Other - Org Name:GEORGETOWN PEDIATRICS, PSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODYKOONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-863-6426
Mailing Address - Street 1:1162 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9330
Mailing Address - Country:US
Mailing Address - Phone:502-863-6426
Mailing Address - Fax:502-868-9724
Practice Address - Street 1:1162 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9330
Practice Address - Country:US
Practice Address - Phone:502-863-6426
Practice Address - Fax:502-868-9724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty