Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 53764 | TN |
NPI | 1043447915 |
---|---|
Provider Name | Allison L Goddard |
First Address | Hixson, TN 37343-5470 |
Second Address | Hixson, TN 37343-5187 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2009 |
Last Update Date | 07/08/2019 |