Provider Demographics
NPI:1437766722
Name:GOODMAN, FLOYD E JR
Entity Type:Individual
Prefix:
First Name:FLOYD
Middle Name:E
Last Name:GOODMAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 CAMPBELLS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25306-6807
Mailing Address - Country:US
Mailing Address - Phone:681-781-3662
Mailing Address - Fax:
Practice Address - Street 1:489 CAMPBELLS CREEK DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25306-6807
Practice Address - Country:US
Practice Address - Phone:681-781-3662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant