MEDICARE: MR. LAWRENCE GOODMAN III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver

General Provider Information

NPI Number	:	1073362661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAWRENCE GOODMAN III

Provider Business Mailing Address
First Line	:	2206 HAVEN DR
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37130-5406
Country	:	US
Telephone Number	:	615-473-4238
Fax Number	:

Provider Business Practice Location Address
First Line	:	2206 HAVEN DR
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37130-5406
Country	:	US
Telephone Number	:	615-473-4238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2024
Last Update Date	:	05/15/2024

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