Healthcare Provider Details

I. General information

NPI: 1639327083
Provider Name (Legal Business Name): MICHAEL DAVID GODBOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 TRANE DR
KNOXVILLE TN
37919-6053
US

IV. Provider business mailing address

341 TRANE DR
KNOXVILLE TN
37919-6053
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9220
  • Fax: 865-637-5518
Mailing address:
  • Phone: 865-305-9220
  • Fax: 865-637-5518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number48324
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: