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General NPI Number Information
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NPI Number | 1104236421
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Entity Type | Organization
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Legal Business Name | OSTEOPATHIC CENTER PLLC
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Dates
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Enumeration Date | 05/08/2014
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 9000 EXECUTIVE PARK DR SUITE A210
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City | KNOXVILLE
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State | TN
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Zip | 37923-4685
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Country | US
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Telephone | 865-321-1732
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Fax | 865-321-1733
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Provider Business Mailing Address
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Address Line | 9000 EXECUTIVE PARK DR SUITE A210
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City | KNOXVILLE
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State | TN
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Zip | 37923-4685
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Country | US
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Telephone | 865-321-1732
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Fax | 865-321-1733
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Authorized Official
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Title or Position | OWNER
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Name | KRISTOPHER JS GODDARD
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Credential | DO
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Telephone | 865-321-1732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | DO0000002081
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License Number State | TN
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