Basic Information
| Provider Information | |||||||||
| NPI: | 1679788947 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODEN | ||||||||
| FirstName: | CHRISTIE | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7777 FOREST LN STE B446 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752305647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725668822 | ||||||||
| FaxNumber: | 9725668861 | ||||||||
| Practice Location | |||||||||
| Address1: | 1968 PEACHTREE RD NW | ||||||||
| Address2: | BLDG 77 5TH FLOOR | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046054600 | ||||||||
| FaxNumber: | 4046096720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204F00000X | 075209 | GA | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 208600000X | R4048 | TX | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.