JENNIFER M GOLDBACH (NPI# 1609884196) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609884196 |
| Entity Type | Individual |
| Full Name | JENNIFER M GOLDBACH |
| Credential | P.A. |
| Practice Address |
304 Turner Mccall Blvd Sw Rome GA 30165-5621 |
| Mailing Address |
420 E 2nd Ave Suite 103 Rome GA 30161-3224 |
| Practice Telephone | 7065095000 |
| Practice Fax Number | 7065094608 |
| Mailing Telephone | 7065093278 |
| Mailing Fax Number | 7065094608 |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2007-07-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
003954 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 664271192A | 05 |
| Street Address |
304 TURNER MCCALL BLVD SW |
| City | ROME |
| State | GA |
| Zip Code | 30165-5621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477501047 | Sonya R Collins | Pediatrics | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2006-05-05 |
| 1316546013 | Forrest Baker Simpson | Registered Nurse | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2020-10-22 |
| 1093324477 | Maggie Brewer | Occupational Therapist | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2020-07-30 |
| 1225646458 | Carril Safia Alexander | Nurse Practitioner | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2020-07-14 |
| 1164049656 | Kim Carlos Farmer | Nurse Practitioner | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2020-06-30 |
| 1497370506 | Nathan Henry | Student in an Organized Health Care Education/Training Program | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2020-06-15 |
| 1124643291 | Gokhan Emre Taskale | Student in an Organized Health Care Education/Training Program | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2020-06-14 |
| 1962027037 | Adriana Delmonico | Student in an Organized Health Care Education/Training Program | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2020-06-14 |
| 1295350494 | Edward Lawson Held | Student in an Organized Health Care Education/Training Program | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2020-06-12 |
| 1740805951 | Yassmin Shariff | Student in an Organized Health Care Education/Training Program | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2020-06-12 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346868775 | Heather Bowman | Physical Therapist | 600 Eagle, E Lake Dr, Rome, GA 30165 | 2020-07-13 |
| 1205451101 | Kristopher Nelson | Student in an Organized Health Care Education/Training Program | 4256, 304 Shorter Ave Nw #201, Rome, GA 30165 | 2020-06-16 |
| 1962061457 | Stuart Paul Shaklee | Occupational Therapy Assistant | 1356 Redmond Road, Rome, GA 30165 | 2019-06-10 |
| 1386001055 | Autumn Streetman | Counselor | 6 Mathis Drive, Rome, GA 30165 | 2016-01-26 |
| 1144695784 | Gabrador Milligan | Counselor | 6 Mathis Road, Rome, GA 30165 | 2015-12-08 |
| 1386041952 | Theresa Suits | Registered Nurse | 1 Woodbine Avenue, Rome, GA 30165 | 2014-11-26 |
| 1942561147 | Nicole C. Christian | Clinical Neuropsychologist | 305 Redmond Rd, Rome, GA 30165 | 2012-06-04 |
| 1679832711 | Niki Pareshkumar Bhavsar | Internal Medicine | 3041 Turner Mccall Blvd, Rome, GA 30165 | 2012-05-10 |
| 1285927491 | Amanda Fischer Reeves | Family Medicine | 304 Shorter Ave Nw Ste 102, Rome, GA 30165 | 2011-05-20 |
| 1033436647 | Northland Hearing Centers, Inc. | Hearing Instrument Specialist | 4 Coosawattee Ave, Rome, GA 30165 | 2010-04-23 |
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| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801402888 | Meredith Gaines | Physician Assistant | 603 W 1st St Unit 1, Rome, GA 30161-3067 | 2020-09-16 |
| 1639153810 | Leone P Cordle | Physician Assistant | 126 Three Rivers Dr Ne, Rome, GA 30161-4999 | 2005-12-01 |
| 1124636527 | Alan Phrommala | Physician Assistant | 501 Redmond Rd Nw, Rome, GA 30165-1415 | 2020-07-21 |
| 1417371642 | William Brandon Newby | Physician Assistant | 18 Riverbend Dr Sw, Suite 120, Rome, GA 30161-6013 | 2014-02-07 |
| 1639437379 | Staci Robin Graves | Physician Assistant | 715 E 2nd Ave Sw, Rome, GA 30161-6148 | 2012-05-01 |
| 1669559795 | Christina Lyndell Miller | Physician Assistant | 1500 N James St, Rome, NY 13440-2844 | 2006-11-01 |
| 1902999865 | Jeffery Scott Roy | Physician Assistant | 91 Perimeter Rd, Suite 100, Rome, NY 13441-4018 | 2006-10-02 |
| 1336258268 | Gregory Lee Fisher | Physician Assistant | 420 E 2nd Ave, Suite 103, Rome, GA 30161-3209 | 2006-08-30 |
| 1093723454 | Henry G. Wood | Physician Assistant | 310 W 10th St Ne, Rome, GA 30165-2639 | 2006-08-03 |
| 1467466946 | Kristofer Ryan Foreman | Physician Assistant | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2006-07-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.