Provider Demographics
NPI:1548610892
Name:GOLIGHTLY, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:GOLIGHTLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W CHOCTAW AVE
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-2213
Mailing Address - Country:US
Mailing Address - Phone:405-222-6500
Mailing Address - Fax:
Practice Address - Street 1:900 W CHOCTAW AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-2213
Practice Address - Country:US
Practice Address - Phone:405-222-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant