Provider Demographics
NPI:1396274478
Name:GOAD, REBECCA (OD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:GOAD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 HAY MARKET RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8609
Mailing Address - Country:US
Mailing Address - Phone:931-436-5382
Mailing Address - Fax:
Practice Address - Street 1:800 MOUNT VERNON HWY NE STE 130
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4293
Practice Address - Country:US
Practice Address - Phone:470-235-4726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3387152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist