Healthcare Provider Details

I. General information

NPI: 1750173597
Provider Name (Legal Business Name): ASHLEY NICOLE GODIER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY NICOLE MORITZ

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 TUSCULUM BLVD
GREENEVILLE TN
37745-4279
US

IV. Provider business mailing address

202 LAMONT ST
JOHNSON CITY TN
37604-6206
US

V. Phone/Fax

Practice location:
  • Phone: 423-787-5000
  • Fax:
Mailing address:
  • Phone: 314-852-7839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: