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General NPI Number Information
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NPI Number | 1497496335
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Entity Type | Individual
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Provider Name | MICHELE GOODMAN
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Gender | Female
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 2685 ANDERSONVILLE HWY STE 1
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City | CLINTON
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State | TN
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Zip | 37716-6725
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Country | US
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Telephone | 865-494-5274
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Fax |
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Provider Business Mailing Address
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Address Line | 3104 HIGHWAY 61 W
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City | ANDERSONVILLE
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State | TN
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Zip | 37705-2101
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Country | US
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Telephone | 865-806-1667
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Fax |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 4369
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License Number State | TN
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