Provider Demographics
NPI:1437278272
Name:GOODE, GARY ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALLEN
Last Name:GOODE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:GARY
Other - Middle Name:ALLEN
Other - Last Name:GOODE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3725 CHAMPION HILLS DR STE 2000
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2510
Practice Address - Country:US
Practice Address - Phone:901-367-9001
Practice Address - Fax:901-565-8787
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1195111N00000X
TN36282363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5926030OtherAETNA ID NUMBER
TN8567089OtherCIGNA ID NUMBER
TN3029427OtherBLUE CROSS BLUE SHIELD ID
TN5926030OtherAETNA ID NUMBER
TNU53337Medicare UPIN