Provider Demographics
NPI:1841909876
Name:GOODWIN, STANASHA TOCCOA (MT)
Entity type:Individual
Prefix:
First Name:STANASHA
Middle Name:TOCCOA
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7527 ROSWELL RD # 566561
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4838
Mailing Address - Country:US
Mailing Address - Phone:404-267-7878
Mailing Address - Fax:404-891-3603
Practice Address - Street 1:7527 ROSWELL RD # 566561
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-4838
Practice Address - Country:US
Practice Address - Phone:404-267-7878
Practice Address - Fax:404-981-3603
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT014308225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist