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General NPI Number Information
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NPI Number | 1639171481
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Entity Type | Individual
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Provider Name | MICHAEL WILLIAM GOODMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 979 E 3RD ST SUITE C0630
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2136
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Country | US
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Telephone | 423-267-5677
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Fax | 423-267-6179
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Provider Business Mailing Address
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Address Line | 979 E 3RD ST SUITE C0630
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2136
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Country | US
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Telephone | 423-267-5677
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Fax | 423-267-6179
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 015401
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 026122
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License Number State | GA
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