Provider Demographics
NPI:1700809605
Name:FLETCHER H GOODE MD PC
Entity Type:Organization
Organization Name:FLETCHER H GOODE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FLETCHER
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:901-872-2206
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38083-0548
Mailing Address - Country:US
Mailing Address - Phone:901-872-2206
Mailing Address - Fax:901-872-2995
Practice Address - Street 1:4759 EASLEY ST
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-1931
Practice Address - Country:US
Practice Address - Phone:901-872-2206
Practice Address - Fax:901-872-2995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2911207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3122277Medicaid
TN3122277Medicaid
TN3374801Medicare PIN
TN0218970001Medicare NSC