Provider Demographics
NPI:1811209620
Name:GOODWIN, JAMI NACOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMI
Middle Name:NACOLE
Last Name:GOODWIN
Suffix:
Gender:F
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 37087
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3087
Mailing Address - Country:US
Mailing Address - Phone:828-687-5616
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:1021 COOLIDGE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4672
Practice Address - Country:US
Practice Address - Phone:423-636-2300
Practice Address - Fax:423-636-0348
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51286207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP01326669OtherPTAN
TN1811209620OtherNPI
TN103I165983Medicare UPIN