Provider Demographics
NPI:1639327083
Name:GODBOLD, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DAVID
Last Name:GODBOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:341 TRANE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6053
Mailing Address - Country:US
Mailing Address - Phone:865-305-9220
Mailing Address - Fax:865-637-5518
Practice Address - Street 1:341 TRANE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6053
Practice Address - Country:US
Practice Address - Phone:865-305-9220
Practice Address - Fax:865-637-5518
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2012-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN48324207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology