Provider Demographics
NPI:1003499054
Name:GOODLETT, GARRETT MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:MARTIN
Last Name:GOODLETT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 HIGHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-9290
Mailing Address - Country:US
Mailing Address - Phone:731-694-3773
Mailing Address - Fax:
Practice Address - Street 1:6320 SAINT AUGUSTINE RD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2813
Practice Address - Country:US
Practice Address - Phone:904-320-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16284111N00000X
FL14326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor