Provider Demographics
NPI:1437833464
Name:GOINES, DARNELL DEWAYNE
Entity Type:Individual
Prefix:
First Name:DARNELL
Middle Name:DEWAYNE
Last Name:GOINES
Suffix:
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 1:7312 MAITLAND LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-9062
Mailing Address - Country:US
Mailing Address - Phone:704-930-1513
Mailing Address - Fax:
Practice Address - Street 1:7312 MAITLAND LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-9062
Practice Address - Country:US
Practice Address - Phone:704-930-1513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12996518347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle