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Johanna Rennhack Goodwin

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

4350 Us 421 S, Lillington, NC 27546-6760

PECOS Enrollment

This provider is enrolled in PECOS as JOHANNA GOODWIN.

Based on the most recent information from CMS, provider Johanna Rennhack Goodwin is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1477172740
Provider Type
Individual
Full Name
Goodwin, Johanna Rennhack
Credential
PA

Gender
Female
Sole Proprietor
No
Enumeration Date
4/15/2020
Last Updated
5/27/2021

Contact Information

Practice Location

4350 Us 421 S, Lillington, NC 27546-6760

(910) 893-1210

Unlisted Fax

Mailing Location

300 E Mcbee Ave Fl 4, Greenville, SC 29601-2842

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 3689 South Carolina
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Johanna Rennhack Goodwin

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

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Description

License

Code

Description

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