Healthcare Provider Details

I. General information

NPI: 1316485865
Provider Name (Legal Business Name): ASHLEY GODFREY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2017
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2391 HIGHWAY 78
DORA AL
35062-5233
US

IV. Provider business mailing address

506 LYNN CIRCLE
MOUNT OLIVE AL
35117
US

V. Phone/Fax

Practice location:
  • Phone: 205-255-7052
  • Fax:
Mailing address:
  • Phone: 205-504-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-144804
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: