Active NPI
Alexander Gray Goodson, OTD, OTR/L
- Occupational Therapist
- Rome, GA
National Provider Identifier
1053153395
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT008893
- Practice address
- 1170 Chulio Rd SE
Rome, GA 30161-4084 - Phone
- (706) 235-1132
- NPI assigned
- Jun 7, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT008893 | GA | Primary |
Addresses
Primary practice location
1170 Chulio Rd SE
Rome, GA 30161-4084
Mailing address
12 Blacksmith LN NW
Cartersville, GA 30120-4386
Other practice location 1
505 N 5th Ave SW
Rome, GA 30165-2822
Phone (706) 291-0521
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717718400000",
"number": "1053153395",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 BLACKSMITH LN NW",
"city": "CARTERSVILLE",
"state": "GA",
"postal_code": "301204386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1170 CHULIO RD SE",
"city": "ROME",
"state": "GA",
"postal_code": "301614084",
"telephone_number": "706-235-1132"
}
],
"practiceLocations": [
{
"address_1": "505 N 5th Ave SW",
"address_purpose": "LOCATION",
"city": "Rome",
"state": "GA",
"postal_code": "301652822",
"country_code": "US",
"telephone_number": "706-291-0521",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GOODSON",
"first_name": "ALEXANDER",
"middle_name": "GRAY",
"credential": "OTD, OTR/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-06-07",
"last_updated": "2024-06-07",
"certification_date": "2024-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "GA",
"license": "OT008893",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rome, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.