Provider Demographics
NPI:1740294305
Name:PERSON, ROBERT GOODWIN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GOODWIN
Last Name:PERSON
Suffix:
Gender:M
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:PO BOX 919
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-0919
Mailing Address - Country:US
Mailing Address - Phone:864-897-8280
Mailing Address - Fax:864-897-8281
Practice Address - Street 1:111 W ROPER RD
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-8805
Practice Address - Country:US
Practice Address - Phone:864-897-8280
Practice Address - Fax:864-897-8281
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC265509Medicaid
SCGP4560Medicaid
SC5664Medicare PIN
SC265509Medicaid
SC1135Medicare PIN