Provider Demographics
NPI:1851513055
Name:GOODSON, CELIA VIVIAN (MD)
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:VIVIAN
Last Name:GOODSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CELIA
Other - Middle Name:VIVIAN
Other - Last Name:CHURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9301 CENTURY OAK CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3321
Mailing Address - Country:US
Mailing Address - Phone:615-315-8920
Mailing Address - Fax:
Practice Address - Street 1:710 JAMES ROBERTSON PKWY
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37243-4906
Practice Address - Country:US
Practice Address - Phone:615-315-8920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49205207R00000X
TN25380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E22984Medicare UPIN