Provider Demographics
NPI:1982854915
Name:GOODWIN, AMY CATHERINE (APRN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CATHERINE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MAPLE ST
Mailing Address - Street 2:DEPT OF NURSING
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30118-0001
Mailing Address - Country:US
Mailing Address - Phone:678-839-5632
Mailing Address - Fax:678-839-6553
Practice Address - Street 1:41 WELLINGTON MILL RD
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:GA
Practice Address - Zip Code:30185-2606
Practice Address - Country:US
Practice Address - Phone:770-836-0504
Practice Address - Fax:770-834-8261
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN118448363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner