Individual
DR. JUSTIN B. MCGOLDRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
110 HOSPITAL DR, JEFFERSON CITY, TN 37760-5281
(865) 471-2500
Mailing address
PO BOX 634706, CINCINNATI, OH 45263-0001
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35270
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3865960
—
TN
05
—
3865961
—
TN
01
—
4014592
BLUE CROSS
TN
01
—
4150060
BLUE CROSS
TN
01
—
P00189111
RAILROAD MEDICARE
TN
Enumeration date
06/14/2006
Last updated
11/06/2007
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