Healthcare Provider Details

I. General information

NPI: 1952542888
Provider Name (Legal Business Name): JENNIFER GOLDSBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W CLINTON ST
GRAY GA
31032-5326
US

IV. Provider business mailing address

565 MONTICELLO HWY
GRAY GA
31032-5513
US

V. Phone/Fax

Practice location:
  • Phone: 478-960-1040
  • Fax:
Mailing address:
  • Phone: 478-960-1040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number129746
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: