MR. LEDONTRAE GOODEN PA-C NPI 1528607272

NPI Information

  • NPI: 1528607272
  • Provider Name: MR. LEDONTRAE GOODEN, PA-C
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 6600 VAN AALST BLVD
    FORT MOORE, GA
    ZIP 31905
  • Phone: (916) 385-1006

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NPI Details

MR. Ledontrae Gooden, PA-C is a medical physician assistant in Fort Moore, GA with 4 years of experience. MR. Ledontrae Gooden, PA-C NPI is 1528607272. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

6600 VAN AALST BLVD
FORT MOORE, GA
ZIP 31905-102
Phone: (916) 385-1006

The NPI 1528607272 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 12/28/2019 and was last updated on 1/22/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AM0700XPhysician AssistantMedicalYes
2172A00000XDriverNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1NONEOTHERNONE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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