Provider Demographics
NPI:1265737241
Name:GOODWIN, MARY CHERKA (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CHERKA
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:281 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-3126
Practice Address - Country:US
Practice Address - Phone:828-245-6400
Practice Address - Fax:828-245-3838
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01310972OtherRAILROAD MEDICARE
SCNCF801C2342423AMedicare PIN