Provider Demographics
NPI:1356331409
Name:GOODRICH, STACEE SHEETS (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEE
Middle Name:SHEETS
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACEE
Other - Middle Name:ELIZABETH
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:111 HANESTOWN CT STE 151
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1749
Mailing Address - Country:US
Mailing Address - Phone:336-765-9350
Mailing Address - Fax:336-760-4255
Practice Address - Street 1:445 PINEVIEW DR STE 110
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3818
Practice Address - Country:US
Practice Address - Phone:336-993-4352
Practice Address - Fax:336-993-3590
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000950207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132JRMedicaid
NC132JROtherBCBS
NCH62230Medicare UPIN
NC89132JRMedicaid