Individual
JERRY BURTON GOOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6027 WALNUT GROVE RD, SUITE 203, MEMPHIS, TN 38120-2145
(901) 226-5957
(901) 226-5940
Mailing address
PO BOX 405827, ATLANTA, GA 30384-5800
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
10805
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09016196
—
MS
05
—
201015716
—
MO
Enumeration date
06/16/2006
Last updated
10/21/2016
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