Provider Demographics
NPI:1336617679
Name:GOODWIN, ASHLEIGH DODDS (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:DODDS
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 GASTON AVE STE 830
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2032
Mailing Address - Country:US
Mailing Address - Phone:214-826-6021
Mailing Address - Fax:214-823-9745
Practice Address - Street 1:3417 GASTON AVE STE 830
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2032
Practice Address - Country:US
Practice Address - Phone:214-826-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17449363A00000X
LA310468363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant