Provider Demographics
NPI:1396391009
Name:GOGGIN, BAILEY CHRISTINE (RDN)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:CHRISTINE
Last Name:GOGGIN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:
Other - Last Name:DERRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:2250 MALL DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-6563
Practice Address - Country:US
Practice Address - Phone:843-876-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-18
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1951133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered