Provider Demographics
NPI:1013345479
Name:GOODIN-ANDERSON, CHASITY
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:
Last Name:GOODIN-ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHASITY
Other - Middle Name:
Other - Last Name:GOODIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:PO BOX 16839
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30081
Mailing Address - Country:US
Mailing Address - Phone:770-685-4023
Mailing Address - Fax:
Practice Address - Street 1:2901 HORSESHOE BEND RD SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4419
Practice Address - Country:US
Practice Address - Phone:770-685-4023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN208567163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse