Healthcare Provider Details

I. General information

NPI: 1205791225
Provider Name (Legal Business Name): GOODENMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BARCELONA DR
COVINGTON GA
30016-6518
US

IV. Provider business mailing address

15 BARCELONA DR
COVINGTON GA
30016-6518
US

V. Phone/Fax

Practice location:
  • Phone: 916-402-6211
  • Fax:
Mailing address:
  • Phone: 916-402-6211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LEDONTRAE GOODEN
Title or Position: PA-C/OWNER
Credential:
Phone: 916-385-1006