Healthcare Provider Details

I. General information

NPI: 1962924738
Provider Name (Legal Business Name): GOOD LIFE HEALTHCARE SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9329 MIDDLEBROOK PIKE
KNOXVILLE TN
37931-4704
US

IV. Provider business mailing address

PO BOX 30608
KNOXVILLE TN
37930-0608
US

V. Phone/Fax

Practice location:
  • Phone: 865-333-1611
  • Fax:
Mailing address:
  • Phone: 865-333-1611
  • Fax: 800-879-9969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDS0000004867
License Number StateTN

VIII. Authorized Official

Name: MRS. DEBRA MARIE HALL - FISHER
Title or Position: PRESIDENT/ CEO
Credential: RDH, RDA
Phone: 865-333-1611