Healthcare Provider Details

I. General information

NPI: 1851873699
Provider Name (Legal Business Name): GREATER GOOD ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 RUSHGROVE CIR
DOVER FL
33527-4953
US

IV. Provider business mailing address

1326 RUSHGROVE CIR
DOVER FL
33527-4953
US

V. Phone/Fax

Practice location:
  • Phone: 941-809-1708
  • Fax:
Mailing address:
  • Phone: 941-809-1708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberCH8003
License Number StateFL

VIII. Authorized Official

Name: DR. STEPHEN D LEE
Title or Position: PRESIDENT
Credential: DC
Phone: 941-809-1708