Healthcare Provider Details

I. General information

NPI: 1770575979
Provider Name (Legal Business Name): PAUL A GOODLETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 STONECREST ROAD SUITE 3
SHELBYVILLE KY
40065
US

IV. Provider business mailing address

101 STONECREST ROAD SUITE 3
SHELBYVILLE KY
40065
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-5565
  • Fax: 502-633-5154
Mailing address:
  • Phone: 502-633-5565
  • Fax: 502-633-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36027
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: