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General NPI Number Information
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NPI Number | 1356331409
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Entity Type | Individual
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Provider Name | STACEE SHEETS GOODRICH MD
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Gender | Female
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 445 PINEVIEW DR STE 110
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City | KERNERSVILLE
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State | NC
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Zip | 27284-3818
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Country | US
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Telephone | 336-993-4352
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Fax | 336-993-3590
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Provider Business Mailing Address
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Address Line | 111 HANESTOWN CT STE 151
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1749
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Country | US
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Telephone | 336-765-9350
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Fax | 336-760-4255
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 200000950
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License Number State | NC
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