Provider Demographics
NPI:1730618679
Name:GOOD, MEREDITH LYNN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:LYNN
Last Name:GOOD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 12TH STREET EXT
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29172-3025
Mailing Address - Country:US
Mailing Address - Phone:803-569-2812
Mailing Address - Fax:803-926-0674
Practice Address - Street 1:4500 12TH STREET EXT
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29172-3025
Practice Address - Country:US
Practice Address - Phone:803-569-2812
Practice Address - Fax:803-926-0674
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2020-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4554Medicaid