Provider Demographics
NPI:1649767468
Name:GOLDY, MARSHA
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:GOLDY
Suffix:
Gender:F
Credentials:
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 790
Mailing Address - Street 2:
Mailing Address - City:OWINGSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40360-0790
Mailing Address - Country:US
Mailing Address - Phone:606-674-6690
Mailing Address - Fax:606-674-6903
Practice Address - Street 1:664 SLATE AVE
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360
Practice Address - Country:US
Practice Address - Phone:606-674-6690
Practice Address - Fax:606-674-6903
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker