Provider Demographics
NPI:1700256484
Name:GOODMAN CENTER, LLC
Entity Type:Organization
Organization Name:GOODMAN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:865-604-3220
Mailing Address - Street 1:116 CONCORD RD
Mailing Address - Street 2:STE 100
Mailing Address - City:FARRAGUT
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2940
Mailing Address - Country:US
Mailing Address - Phone:865-604-3220
Mailing Address - Fax:
Practice Address - Street 1:116 CONCORD RD
Practice Address - Street 2:STE 100
Practice Address - City:FARRAGUT
Practice Address - State:TN
Practice Address - Zip Code:37934-2940
Practice Address - Country:US
Practice Address - Phone:865-604-3220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty