Healthcare Provider Details

I. General information

NPI: 1093700833
Provider Name (Legal Business Name): GOODLETTSVILLE PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 BUSINESS PARK CIR STE 100
GOODLETTSVILLE TN
37072-3676
US

IV. Provider business mailing address

3103 BUSINESS PARK CIR STE 100
GOODLETTSVILLE TN
37072-3676
US

V. Phone/Fax

Practice location:
  • Phone: 615-851-7865
  • Fax: 615-851-7853
Mailing address:
  • Phone: 615-851-7865
  • Fax: 615-851-7853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATTY A SCHLEICHER
Title or Position: OFFICE MANAGER
Credential:
Phone: 615-851-7865