Healthcare Provider Details

I. General information

NPI: 1235208380
Provider Name (Legal Business Name): JULIA GREEN GOODALL WEEKS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 HODGES DR
TALLAHASSEE FL
32308-4614
US

IV. Provider business mailing address

1301 HODGES DR
TALLAHASSEE FL
32308-4614
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-5741
  • Fax: 850-431-6403
Mailing address:
  • Phone: 850-431-5741
  • Fax: 850-431-6403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number049119
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME77667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: