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General NPI Number Information
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NPI Number | 1811134323
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Entity Type | Organization
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Legal Business Name | GOODE MEDICINE LLC
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Dates
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Enumeration Date | 01/21/2009
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Last Update Date | 01/21/2009
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Provider Practice Location Address
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Address Line | 101 E PAULK AVE SUITE B
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City | OPP
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State | AL
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Zip | 36467-1727
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Country | US
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Telephone | 334-493-0233
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Fax | 334-493-0274
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Provider Business Mailing Address
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Address Line | 101 E PAULK AVE SUITE B
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City | OPP
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State | AL
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Zip | 36467-1727
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Country | US
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Telephone | 334-493-0233
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Fax | 334-493-0274
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Authorized Official
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Title or Position | OWNER
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Name | DR. STACY C GOODE
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Credential | M.D.
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Telephone | 334-493-0233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 27479
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License Number State | AL
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