Healthcare Provider Details

I. General information

NPI: 1649294083
Provider Name (Legal Business Name): DAVID J GOODE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

964 AVON RD
WINSTON SALEM NC
27104-1014
US

IV. Provider business mailing address

964 AVON RD
WINSTON SALEM NC
27104-1014
US

V. Phone/Fax

Practice location:
  • Phone: 336-761-0326
  • Fax: 336-760-0524
Mailing address:
  • Phone: 336-761-0326
  • Fax: 336-760-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15075
License Number StateNC

VIII. Authorized Official

Name: DAVID JOHN GOODE
Title or Position: PRESIDENT
Credential: MD
Phone: 336-761-0326