1689677155 NPI number — DR. JAMES A GOODSON III M.D.

Table of content: DR. JAMES A GOODSON III M.D. (NPI 1689677155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689677155 NPI number — DR. JAMES A GOODSON III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOODSON
Provider First Name:
JAMES
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689677155
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
367 WEST EVANS STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29501-3429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-669-4156
Provider Business Mailing Address Fax Number:
843-664-2121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
365 W WESMARK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29150-1987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-905-8020
Provider Business Practice Location Address Fax Number:
803-905-8025
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  19334 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: S327577 . This is a "CIGNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 9624212 . This is a "GHI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 180039403 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 20036069 . This is a "SELECT HEALTH" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 9060247 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: T36128 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5418708 . This is a "AETNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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