Provider Demographics
NPI:1922539550
Name:GOODFELLOW, AMELIA (MD)
Entity type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:
Last Name:GOODFELLOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2ND MARINE RAIDER BATTALION, BATTALION AID STATION
Mailing Address - Street 2:PSC BOX 20183
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0183
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:GME OFFICE 303 LIGHT HALL
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0183
Practice Address - Country:US
Practice Address - Phone:615-322-4916
Practice Address - Fax:615-343-1496
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN