Provider Demographics
NPI:1275945909
Name:GOODRUM, ALISHA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISHA
Middle Name:
Last Name:GOODRUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ALISHA
Other - Middle Name:
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 MISSION ST STE 800
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-1744
Mailing Address - Country:US
Mailing Address - Phone:415-231-5333
Mailing Address - Fax:415-231-5332
Practice Address - Street 1:101 MISSION ST STE 800
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-1744
Practice Address - Country:US
Practice Address - Phone:415-231-5333
Practice Address - Fax:415-231-5332
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA079346207Q00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine