Provider Demographics
NPI:1639171481
Name:GOODMAN, MICHAEL WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 E 3RD ST
Mailing Address - Street 2:SUITE C0630
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-267-5677
Mailing Address - Fax:423-267-6179
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:SUITE C0630
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-267-5677
Practice Address - Fax:423-267-6179
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN015401207RG0100X
GA026122207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN192613OtherBLUE CROSS BLUE SHIELD OF
TN3006410Medicaid
TN100005904OtherRAILROAD MEDICARE
TN621553135003OtherCIGNA
GT23445OtherUNITED HEALTH CARE
GT23445OtherUNITED HEALTH CARE
TNA97106Medicare UPIN
TN192613OtherBLUE CROSS BLUE SHIELD OF