Provider Demographics
NPI:1225433873
Name:GOSHORN AESTHETIC CLINIC PLLC
Entity Type:Organization
Organization Name:GOSHORN AESTHETIC CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:NEUMON
Authorized Official - Middle Name:T
Authorized Official - Last Name:GOSHORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-682-4456
Mailing Address - Street 1:1364 CORDOVA CV
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2200
Mailing Address - Country:US
Mailing Address - Phone:901-682-4466
Mailing Address - Fax:901-207-4882
Practice Address - Street 1:1364 CORDOVA CV
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2200
Practice Address - Country:US
Practice Address - Phone:901-682-4466
Practice Address - Fax:901-207-4882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty