Provider Demographics
NPI:1780254243
Name:GOOLSBY, JOHN WILLIAM III
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:GOOLSBY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N JEFFERSON ST # C
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-6302
Mailing Address - Country:US
Mailing Address - Phone:478-292-5755
Mailing Address - Fax:
Practice Address - Street 1:600 N JEFFERSON ST # C
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-6302
Practice Address - Country:US
Practice Address - Phone:478-292-5755
Practice Address - Fax:877-374-5772
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator