Healthcare Provider Details

I. General information

NPI: 1356331409
Provider Name (Legal Business Name): STACEE SHEETS GOODRICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEE ELIZABETH REYNOLDS MD

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 PINEVIEW DR STE 110
KERNERSVILLE NC
27284-3818
US

IV. Provider business mailing address

111 HANESTOWN CT STE 151
WINSTON SALEM NC
27103-1749
US

V. Phone/Fax

Practice location:
  • Phone: 336-993-4352
  • Fax: 336-993-3590
Mailing address:
  • Phone: 336-765-9350
  • Fax: 336-760-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number200000950
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: