Provider Demographics
NPI:1710283460
Name:GOODCHILD, MALCOLM INGRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:INGRAM
Last Name:GOODCHILD
Suffix:
Gender:M
Credentials:MD
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 1038
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-1038
Mailing Address - Country:US
Mailing Address - Phone:706-660-2950
Mailing Address - Fax:706-660-2975
Practice Address - Street 1:2737 WARM SPRINGS RD
Practice Address - Street 2:BUILDING A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6859
Practice Address - Country:US
Practice Address - Phone:706-660-2950
Practice Address - Fax:706-660-2975
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2600952086S0127X
GA0765592086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery