Provider Demographics
NPI:1851344857
Name:GOFF, GISELE ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GISELE
Middle Name:ALLEN
Last Name:GOFF
Suffix:
Gender:F
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:PO BOX 102906
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2906
Mailing Address - Country:US
Mailing Address - Phone:901-377-3475
Mailing Address - Fax:901-377-8068
Practice Address - Street 1:6555 STAGE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2810
Practice Address - Country:US
Practice Address - Phone:901-377-3475
Practice Address - Fax:901-377-8068
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3157198OtherBLUE CROSS INDIVIDUAL PRO
TNH16237Medicare UPIN
TN3157198OtherBLUE CROSS INDIVIDUAL PRO
TN3851697Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE