Provider Demographics
NPI:1851538730
Name:AUBURN UNIVERSITY
Entity Type:Organization
Organization Name:AUBURN UNIVERSITY
Other - Org Name:AUBURN UNIVERSITY SPORTS MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:TEAM PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOODLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-844-9821
Mailing Address - Street 1:349 S DONAHUE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36849-0001
Mailing Address - Country:US
Mailing Address - Phone:334-844-9821
Mailing Address - Fax:334-844-0932
Practice Address - Street 1:349 S DONAHUE DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36849-0001
Practice Address - Country:US
Practice Address - Phone:334-844-9821
Practice Address - Fax:334-844-0932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10954261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service