Provider Demographics
NPI:1962924738
Name:GOOD LIFE HEALTHCARE SOLUTIONS, INC
Entity type:Organization
Organization Name:GOOD LIFE HEALTHCARE SOLUTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HALL - FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, RDA
Authorized Official - Phone:865-333-1611
Mailing Address - Street 1:PO BOX 30608
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-0608
Mailing Address - Country:US
Mailing Address - Phone:865-333-1611
Mailing Address - Fax:800-879-9969
Practice Address - Street 1:9329 MIDDLEBROOK PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-4704
Practice Address - Country:US
Practice Address - Phone:865-333-1611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000048671223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1578665923OtherRONALD W. SMITH, DDS
TN1417052903OtherDAVID B. LEE, DDS
TN1003961780OtherCHARLES DANIEL FISHER, DDS