Provider Demographics
NPI:1295266294
Name:GOODWIN, RACHEL PARDUE (DO)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:PARDUE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 CLINCH AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2435
Mailing Address - Country:US
Mailing Address - Phone:865-546-5111
Mailing Address - Fax:865-374-2095
Practice Address - Street 1:1819 CLINCH AVE STE 108
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2435
Practice Address - Country:US
Practice Address - Phone:865-546-5111
Practice Address - Fax:865-374-2095
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6266207RI0011X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ058745Medicaid