Provider Demographics
NPI:1891904579
Name:GOODWIN COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:GOODWIN COMMUNITY HEALTH CENTER
Other - Org Name:COASTAL MEDICAL ACCESS PROJECT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOTA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSPL
Authorized Official - Phone:912-554-3559
Mailing Address - Street 1:104 LAKESHORE DR
Mailing Address - Street 2:STE E
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3803
Mailing Address - Country:US
Mailing Address - Phone:912-554-3559
Mailing Address - Fax:912-554-8344
Practice Address - Street 1:3010 HAMPTON AVE
Practice Address - Street 2:STE 6
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4224
Practice Address - Country:US
Practice Address - Phone:912-466-8909
Practice Address - Fax:912-466-8995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center