Provider Demographics
NPI:1265469969
Name:GOING, JACQUELYN A (MD)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:A
Last Name:GOING
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 1:9 RICHLAND MEDICAL PARK
Mailing Address - Street 2:STE 510
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6860
Mailing Address - Country:US
Mailing Address - Phone:803-256-2483
Mailing Address - Fax:803-799-4624
Practice Address - Street 1:9 RICHLAND MEDICAL PARK
Practice Address - Street 2:STE 510
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6860
Practice Address - Country:US
Practice Address - Phone:803-256-2483
Practice Address - Fax:803-799-4624
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8384207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
20068859OtherSELECT HEALTH
DC6996OtherMEDICARE RAILROAD GROUP NUMBER
P00184835OtherMEDICARE RAILROAD
SC083849Medicaid
PA1382OtherMEDICAID GROUP NUMBER
SC1305Medicare PIN
P00184835OtherMEDICARE RAILROAD