Provider Demographics
NPI:1649165549
Name:GOODWIN, JAIMIA SADE
Entity type:Individual
Prefix:
First Name:JAIMIA
Middle Name:SADE
Last Name:GOODWIN
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 1:1685 WALLEYE DR
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2325
Mailing Address - Country:US
Mailing Address - Phone:202-699-2314
Mailing Address - Fax:
Practice Address - Street 1:1685 WALLEYE DR
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2325
Practice Address - Country:US
Practice Address - Phone:202-699-2314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator