MEDICARE: JESSICA DAVIS GOODEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	RN247090	GA

General Provider Information

NPI Number	:	1619836038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA DAVIS GOODEN

Provider Business Mailing Address
First Line	:	3915 PEACE VALLEY DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-1509
Country	:	US
Telephone Number	:	540-270-7161
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 GEES MILL RD NE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-1362
Country	:	US
Telephone Number	:	470-249-1083
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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