Provider Demographics
NPI:1548458375
Name:GOINS, CARL DOUGLAS III (PAC)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:DOUGLAS
Last Name:GOINS
Suffix:III
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 CENTERPOINT BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1983
Mailing Address - Country:US
Mailing Address - Phone:865-985-7012
Mailing Address - Fax:865-985-7077
Practice Address - Street 1:1431 CENTERPOINT BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-1983
Practice Address - Country:US
Practice Address - Phone:865-985-7012
Practice Address - Fax:865-985-7077
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363A00000X
TN1546363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical