Provider Demographics
NPI:1255066650
Name:GOINGS, KATHLEEN CARRIE KAMAKAOKALANI
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CARRIE KAMAKAOKALANI
Last Name:GOINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 TURNBERRY ST
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-1925
Mailing Address - Country:US
Mailing Address - Phone:912-704-4722
Mailing Address - Fax:
Practice Address - Street 1:5105 PAULSEN ST STE 141B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4609
Practice Address - Country:US
Practice Address - Phone:912-704-4722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT005085225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty