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Mr. Ledontrae Gooden, PA-C
Driver in Fort Moore, Georgia
NPI 1528607272

Ledontrae Gooden is a Driver based in Fort Moore, GA. Ledontrae Gooden practices in Fort Moore, GA and has the professional credentials of PA-C. The NPI Number for Ledontrae Gooden is 1528607272 and holds a License No. (Georgia).

The current practice location address for Ledontrae Gooden is 6600 Van Aalst Blvd, Fort Moore, GA and can be reached out via phone at 916-385-1006.

Location: 6600 Van Aalst Blvd, Fort Moore, GA, 31905-2102
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1528607272
Provider Name
Ledontrae Gooden
Credential
PA-C
Provider Entity Type
Individual
Gender
Male
Address
6600 Van Aalst Blvd, Fort Moore, GA, 31905-2102
Phone Number
916-385-1006
Fax Number
Provider Enumeration Date
12/28/2019
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
NONE 01 NONE
institution
Provider Business Practice Location Address Details
Address
6600 Van Aalst Blvd
City
Fort Moore
State
Georgia
Zip
31905-2102
Phone Number
916-385-1006
Fax Number
person
Provider Business Mailing Address Details
Address
6600 Van Aalst Blvd
City
Fort Moore
State
Georgia
Zip
31905-2102
Phone Number
916-385-1006
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Driver
Speciality
-
Taxonomy
172A00000X
License No.
()
Definition
A person employed to operate a motor vehicle as a carrier of persons or property.
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
363AM0700X
License No.
()
Definition
Definition to come...
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