Provider Demographics
NPI:1013925023
Name:GOODE, PANDORA (NP C)
Entity Type:Individual
Prefix:
First Name:PANDORA
Middle Name:
Last Name:GOODE
Suffix:
Gender:F
Credentials:NP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 YANCEYVILLE ST
Mailing Address - Street 2:ALPHA MEDICAL CLINIC
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-4043
Mailing Address - Country:US
Mailing Address - Phone:336-358-1578
Mailing Address - Fax:336-358-1582
Practice Address - Street 1:3231 YANCEYVILLE ST
Practice Address - Street 2:ALPHA MEDICAL CLINIC
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-4043
Practice Address - Country:US
Practice Address - Phone:336-358-1578
Practice Address - Fax:336-358-1582
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF913091CMedicaid
2002147AMedicare ID - Type Unspecified
H18113Medicare UPIN