Provider Demographics
NPI:1700452927
Name:GOEBEL, ALYSSA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:MICHELLE
Last Name:GOEBEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7635 TRAILSIDE CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-1094
Mailing Address - Country:US
Mailing Address - Phone:618-975-0253
Mailing Address - Fax:
Practice Address - Street 1:6225 HUMPHREYS BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2373
Practice Address - Country:US
Practice Address - Phone:901-227-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program