Provider Demographics
NPI:1083939680
Name:GOODCHILD, CHARLEEN C (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:CHARLEEN
Middle Name:C
Last Name:GOODCHILD
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 ROSEMONT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-5659
Mailing Address - Country:US
Mailing Address - Phone:706-221-6770
Mailing Address - Fax:706-221-6776
Practice Address - Street 1:3830 ROSEMONT DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5659
Practice Address - Country:US
Practice Address - Phone:706-221-6770
Practice Address - Fax:706-221-6776
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007347363A00000X, 363AM0700X, 363AS0400X
GA8208363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical