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General NPI Number Information
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NPI Number | 1700647872
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Entity Type | Individual
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Provider Name | JESSICA ANNE GOEDJEN APRN
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Gender | Female
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Dates
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Enumeration Date | 01/17/2024
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 401 S MAIN ST STE A4
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City | ALPHARETTA
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State | GA
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Zip | 30009-1957
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Country | US
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Telephone | 313-598-2272
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Fax |
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Provider Business Mailing Address
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Address Line | 1396 CANOOCHEE DR NE
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City | BROOKHAVEN
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State | GA
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Zip | 30319-3432
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Country | US
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Telephone | 313-598-2272
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN-NP247558
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN247558
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License Number State | GA
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