Thekla Meli Goudeau, RDH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

11719 Issued in NC

Practice address

1510 6TH Ave Unit 108
Columbus, GA 31901-2652

Phone

(704) 962-7969

NPI assigned

Jun 1, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1609515253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 6TH AVE UNIT 108",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319012652",
            "telephone_number": "704-962-7969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 6TH AVE UNIT 108",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319012652",
            "telephone_number": "704-962-7969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOUDEAU",
        "first_name": "THEKLA",
        "middle_name": "MELI",
        "credential": "RDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-01",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "KS",
            "license": "12900",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "GA",
            "license": "DH044923",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "NC",
            "license": "11719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Breniah Graddy

• Dental Hygienist in Columbus, GA
• Providers in Columbus, GA by specialty
• Dental Hygienist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.

Verify at the official NPI Registry.