Provider Demographics
NPI:1801925938
Name:GOOLSBY, JASON BRYANT (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:BRYANT
Last Name:GOOLSBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2290 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38012-1607
Mailing Address - Country:US
Mailing Address - Phone:731-772-5183
Mailing Address - Fax:731-772-2781
Practice Address - Street 1:2290 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38012-1607
Practice Address - Country:US
Practice Address - Phone:731-772-5183
Practice Address - Fax:731-772-2781
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine