Healthcare Provider Details

I. General information

NPI: 1265100358
Provider Name (Legal Business Name): BRYON KEITH GOODMAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 STONECREST BLVD
SMYRNA TN
37167-6810
US

IV. Provider business mailing address

1913 GUILDFORD DR
LA VERGNE TN
37086-3083
US

V. Phone/Fax

Practice location:
  • Phone: 615-768-2000
  • Fax:
Mailing address:
  • Phone: 731-412-6424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number231518
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: