Healthcare Provider Details

I. General information

NPI: 1033383310
Provider Name (Legal Business Name): GODSEY ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BROYLES ST
JOHNSON CITY TN
37601-2532
US

IV. Provider business mailing address

111 BROYLES ST
JOHNSON CITY TN
37601-2532
US

V. Phone/Fax

Practice location:
  • Phone: 423-282-1932
  • Fax: 423-282-8813
Mailing address:
  • Phone: 423-282-1932
  • Fax: 423-282-8813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDPO174
License Number StateTN

VIII. Authorized Official

Name: KELLY GODSEY
Title or Position: OWNER
Credential:
Phone: 423-282-1932