Provider Demographics
NPI:1598745325
Name:GOODNOUGH, TAYLOR K (DO)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:K
Last Name:GOODNOUGH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2402 WAYNE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1728
Mailing Address - Country:US
Mailing Address - Phone:919-735-1387
Mailing Address - Fax:910-853-6022
Practice Address - Street 1:5306 NC HIGHWAY 55 STE 105
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7812
Practice Address - Country:US
Practice Address - Phone:919-646-4858
Practice Address - Fax:919-679-7112
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01879207QG0300X, 207QH0002X
PAOS013113207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1598745325Medicaid
I45164Medicare UPIN
P00371219Medicare PIN