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General NPI Number Information
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NPI Number | 1114637501
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Entity Type | Individual
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Provider Name | ALEXANDRA GOODMAN
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Gender | Female
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Dates
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Enumeration Date | 11/28/2022
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 5328 LANIER ISLANDS PKWY UNIT 101
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City | BUFORD
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State | GA
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Zip | 30518-9071
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Country | US
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Telephone | 470-655-1970
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Fax |
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Provider Business Mailing Address
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Address Line | 5328 LANIER ISLANDS PKWY UNIT 101
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City | BUFORD
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State | GA
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Zip | 30518-9071
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Country | US
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Telephone | 470-655-1970
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-255896
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License Number State | GA
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