Provider Demographics
NPI:1124043880
Name:CHAFFIN, GOODLOE SUMMERS JR (MD)
Entity Type:Individual
Prefix:MR
First Name:GOODLOE
Middle Name:SUMMERS
Last Name:CHAFFIN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:107 GLEN OAK BLVD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3162
Mailing Address - Country:US
Mailing Address - Phone:615-822-2400
Mailing Address - Fax:615-822-6941
Practice Address - Street 1:107 GLEN OAK BLVD.
Practice Address - Street 2:SUITE 201
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3162
Practice Address - Country:US
Practice Address - Phone:615-822-2400
Practice Address - Fax:615-822-9641
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-04-15
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Provider Licenses
StateLicense IDTaxonomies
TNMD009859207Q00000X
TNMD0000009859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D32210Medicare UPIN
TN3196731Medicare ID - Type Unspecified
TN31967301Medicare PIN