Provider Demographics
NPI:1700091873
Name:MICHAEL W GOODMAN MD PC
Entity Type:Organization
Organization Name:MICHAEL W GOODMAN MD PC
Other - Org Name:GOODMAN & EBERLE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-267-5677
Mailing Address - Street 1:979 E 3RD ST STE C630
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-3348
Mailing Address - Country:US
Mailing Address - Phone:423-267-5677
Mailing Address - Fax:
Practice Address - Street 1:979 E 3RD ST STE C630
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-3348
Practice Address - Country:US
Practice Address - Phone:423-267-5677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN015401174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3704781Medicare ID - Type UnspecifiedGROUP NUMBER
TNCB9984Medicare ID - Type UnspecifiedRAILROAD