Provider Demographics
NPI:1508222993
Name:GOODSON-REDMOND, ROSETTA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ROSETTA
Middle Name:
Last Name:GOODSON-REDMOND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:ROSETTA
Other - Middle Name:
Other - Last Name:GOODSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-228-1767
Mailing Address - Fax:770-228-7562
Practice Address - Street 1:747 SOUTH 8TH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4880
Practice Address - Country:US
Practice Address - Phone:678-288-9555
Practice Address - Fax:678-288-9556
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF1015699363LF0000X
GARN171233363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I503298OtherMEDICARE PTAN
GA003173975DMedicaid
GA003173975CMedicaid