Provider Demographics
NPI:1326285933
Name:GOODWIN, ADOLPHINA
Entity Type:Individual
Prefix:MS
First Name:ADOLPHINA
Middle Name:
Last Name:GOODWIN
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 1:5760 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4005
Mailing Address - Country:US
Mailing Address - Phone:312-924-9400
Mailing Address - Fax:312-924-9444
Practice Address - Street 1:5760 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-4005
Practice Address - Country:US
Practice Address - Phone:312-924-9400
Practice Address - Fax:312-924-9444
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2471S1302X, 251C00000X, 251E00000X, 253Z00000X, 261Q00000X, 332U00000X, 372500000X, 374U00000X, 376J00000X
IL1262859332471S1302X
IL13262859332471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332U00000XSuppliersHome Delivered Meals
No372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker