Provider Demographics
NPI:1376873521
Name:GOOD HEALTH FAMILY CLINIC, INC
Entity Type:Organization
Organization Name:GOOD HEALTH FAMILY CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-597-4432
Mailing Address - Street 1:414 E BROAD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166
Mailing Address - Country:US
Mailing Address - Phone:615-597-4432
Mailing Address - Fax:615-597-4434
Practice Address - Street 1:414 E BROAD ST
Practice Address - Street 2:SUITE C
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166
Practice Address - Country:US
Practice Address - Phone:615-597-4432
Practice Address - Fax:615-597-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN12888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN33420181Medicaid
TN33420181Medicare PIN