Provider Demographics
NPI:1104474717
Name:GOAD, JUSTIN T
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:T
Last Name:GOAD
Suffix:
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 1:4821 COUNTY ROAD 24
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634-5725
Mailing Address - Country:US
Mailing Address - Phone:256-335-4031
Mailing Address - Fax:
Practice Address - Street 1:4821 COUNTY ROAD 24
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35634-5725
Practice Address - Country:US
Practice Address - Phone:256-335-4031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6051779347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle