Provider Demographics
NPI:1609230853
Name:GOGGINS, LISA (CLC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GOGGINS
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5363
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31414-5363
Mailing Address - Country:US
Mailing Address - Phone:912-662-5069
Mailing Address - Fax:
Practice Address - Street 1:8505 WATERS AVE
Practice Address - Street 2:APT 66
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-6036
Practice Address - Country:US
Practice Address - Phone:912-662-5069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator