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General NPI Number Information
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NPI Number | 1174611883
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Entity Type | Individual
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Provider Name | JAMES GOODE CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 7300 VAN DUSEN RD
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City | LAUREL
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State | MD
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Zip | 20707-9463
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Country | US
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Telephone | 443-332-4088
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Fax | 410-793-0809
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Provider Business Mailing Address
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Address Line | 11517 LADY ALISON CT
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City | WALDORF
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State | MD
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Zip | 20601-4627
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Country | US
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Telephone | 240-607-9061
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Fax | 240-607-9061
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R1800054
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License Number State | MD
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