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General NPI Number Information
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NPI Number | 1962924738
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Entity Type | Organization
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Legal Business Name | GOOD LIFE HEALTHCARE SOLUTIONS, INC
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 9329 MIDDLEBROOK PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37931-4704
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Country | US
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Telephone | 865-333-1611
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30608
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City | KNOXVILLE
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State | TN
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Zip | 37930-0608
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Country | US
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Telephone | 865-333-1611
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Fax | 800-879-9969
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Authorized Official
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Title or Position | PRESIDENT/ CEO
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Name | MRS. DEBRA MARIE HALL - FISHER
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Credential | RDH, RDA
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Telephone | 865-333-1611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | DS0000004867
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License Number State | TN
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