Provider Demographics
NPI:1710959424
Name:FLOYD, MICHELLE GOOCH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:GOOCH
Last Name:FLOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDRIA
Other - Middle Name:MICHELLE
Other - Last Name:GOOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:SELF MEDICAL GROUP - FAMILY HEALTHCARE OF GREENWOOD
Mailing Address - Street 2:116 VENTURE COURT
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649
Mailing Address - Country:US
Mailing Address - Phone:864-725-5594
Mailing Address - Fax:864-725-5598
Practice Address - Street 1:SELF MEDICAL GROUP - FAMILY HEALTHCARE OF GREENWOOD
Practice Address - Street 2:116 VENTURE COURT
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649
Practice Address - Country:US
Practice Address - Phone:864-725-5594
Practice Address - Fax:864-725-5598
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG54852Medicare UPIN