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General NPI Number Information
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NPI Number | 1225433873
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Entity Type | Organization
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Legal Business Name | GOSHORN AESTHETIC CLINIC PLLC
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 1364 CORDOVA CV
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City | GERMANTOWN
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State | TN
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Zip | 38138-2200
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Country | US
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Telephone | 901-682-4466
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Fax | 901-207-4882
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Provider Business Mailing Address
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Address Line | 1364 CORDOVA CV
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City | GERMANTOWN
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State | TN
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Zip | 38138-2200
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Country | US
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Telephone | 901-682-4466
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Fax | 901-207-4882
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | MR. NEUMON T GOSHORN
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Credential | M.D.
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Telephone | 901-682-4456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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