Provider Demographics
NPI:1649294083
Name:DAVID J GOODE MD PA
Entity type:Organization
Organization Name:DAVID J GOODE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-761-0326
Mailing Address - Street 1:964 AVON RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-1014
Mailing Address - Country:US
Mailing Address - Phone:336-761-0326
Mailing Address - Fax:336-760-0524
Practice Address - Street 1:964 AVON RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-1014
Practice Address - Country:US
Practice Address - Phone:336-761-0326
Practice Address - Fax:336-760-0524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC150752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC36186OtherBLUE CROSS/BLUE SHIELD
NC86 36186Medicaid
NCC84113Medicare UPIN
NC36186OtherBLUE CROSS/BLUE SHIELD