Provider Demographics
NPI:1346714615
Name:GOOD DOCTOR
Entity Type:Organization
Organization Name:GOOD DOCTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-737-0904
Mailing Address - Street 1:4145 NORTH MAYO TRAIL, BOX 252
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3211
Mailing Address - Country:US
Mailing Address - Phone:606-899-2273
Mailing Address - Fax:606-899-2273
Practice Address - Street 1:9405 US HIGHWAY 235
Practice Address - Street 2:
Practice Address - City:STANVILLE
Practice Address - State:KY
Practice Address - Zip Code:41659-9048
Practice Address - Country:US
Practice Address - Phone:606-899-2273
Practice Address - Fax:606-899-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-19
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center