Healthcare Provider Details

I. General information

NPI: 1104041409
Provider Name (Legal Business Name): GEOFFREY SCHAEFFER GOODIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 JEFFERSON AVE
MEMPHIS TN
38103-2807
US

IV. Provider business mailing address

2767 IROQUOIS RD
MEMPHIS TN
38111-2015
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-5364
  • Fax:
Mailing address:
  • Phone: 901-937-9863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number44127
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number44127
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: