Healthcare Provider Details

I. General information

NPI: 1013300227
Provider Name (Legal Business Name): RACHEL GOODSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 02/18/2023
Certification Date: 02/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 FORSYTH ST
MACON GA
31201-2051
US

IV. Provider business mailing address

1014 FORSYTH ST
MACON GA
31201-2051
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-8100
  • Fax: 478-633-6268
Mailing address:
  • Phone: 478-633-8100
  • Fax: 478-633-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number008435
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number92364
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number92364
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: