Basic Information
| Provider Information | |||||||||
| NPI: | 1710283460 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODCHILD | ||||||||
| FirstName: | MALCOLM | ||||||||
| MiddleName: | INGRAM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1038 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319021038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066602950 | ||||||||
| FaxNumber: | 7066602975 | ||||||||
| Practice Location | |||||||||
| Address1: | 2737 WARM SPRINGS RD | ||||||||
| Address2: | BUILDING A | ||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319046859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066602950 | ||||||||
| FaxNumber: | 7066602975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2011 | ||||||||
| LastUpdateDate: | 08/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0127X | 260095 | NY | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0127X | 076559 | GA | Y | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery |
No ID Information.