Provider Demographics
NPI:1154399863
Name:GOODLETT, MICHAEL D (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:GOODLETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:349 SOUTH DONAHUE DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36849
Mailing Address - Country:US
Mailing Address - Phone:334-844-9821
Mailing Address - Fax:334-844-0932
Practice Address - Street 1:349 SOUTH DONAHUE DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36849
Practice Address - Country:US
Practice Address - Phone:334-844-9821
Practice Address - Fax:334-844-0932
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL10954207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51521101OtherBLUE CROSS
C72284Medicare UPIN
AL000027227Medicare PIN