Provider Demographics
NPI:1104908144
Name:GOOLSBY, BRENDA B (RN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:B
Last Name:GOOLSBY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 KELLY ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:GA
Mailing Address - Zip Code:30817-2800
Mailing Address - Country:US
Mailing Address - Phone:706-359-1196
Mailing Address - Fax:
Practice Address - Street 1:176 N. PEACHTREE STREET
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:GA
Practice Address - Zip Code:30817
Practice Address - Country:US
Practice Address - Phone:706-359-3154
Practice Address - Fax:706-359-1939
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN054204163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health