Provider Demographics
NPI:1619410966
Name:GOODWIN, JOSEPH (LMBT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-3209
Mailing Address - Country:US
Mailing Address - Phone:828-429-3875
Mailing Address - Fax:
Practice Address - Street 1:200 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-3209
Practice Address - Country:US
Practice Address - Phone:828-429-3875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12883171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor