Theresa G. Goodman, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP-06471 Issued in OH

Practice address

605 Ashton Manor Dr
Loganville, GA 30052-5330

Phone

(216) 406-2466

Fax

(770) 554-1621

NPI assigned

Aug 19, 2005

Last updated

Feb 11, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Theresa G. Spencer Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• David E Kim MD PC

  • Internal Medicine Physician
  • Cartersville, GA
  • NPI 1194919381
  NPD (past)

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202688000000",
    "number": "1609868298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 ASHTON MANOR DR",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300525330",
            "telephone_number": "216-406-2466",
            "fax_number": "770-554-1621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 ASHTON MANOR DR",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300525330",
            "telephone_number": "216-406-2466",
            "fax_number": "770-554-1621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "THERESA",
        "middle_name": "G.",
        "name_prefix": "Ms.",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-19",
        "last_updated": "2008-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "NP-06471",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN152359 NP",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THERESA",
            "last_name": "SPENCER",
            "middle_name": "G.",
            "prefix": "MS.",
            "credential": "NP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amanda Gnath
• Stuart Gnath, PHARM.D.
• Goal Diggaz Medical Services LLC
• Shami Gokhale
• Joav Gomez, PT, DPT
• Kareen Marie Gordon
• Chandan Gosar, OTR
• Simone Goss
• Gracey Manor LLC
• Wendy K Grage, CSFA

• Family Nurse Practitioner in Loganville, GA
• Providers in Loganville, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; 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.