Doctor Name: | MICHELE L. GOODBREAD |
NPI Number: | 1073796108 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | P.A. |
License Number: | MA053005 |
Business Practice Address: | 222 Oak St Mountain City, TN - 376831526 |
Business Phone Number: | 4237276319 |
Business Fax Number: | 4237274164 |
Mailing Address: | Po Box 850, ROGERSVILLE |
State: | TN |
Postal Code: | 378570850 |
Phone Number: | 4237276319 |
Fax Number: | 4237274164 |
NPI Enumeration Date: | 12/12/2007 |
NPI Last Update Date: | 06/22/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | MA053005 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |