Healthcare Provider Details

I. General information

NPI: 1891745782
Provider Name (Legal Business Name): RAYMOND D. GODSIL JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 NORTH 20TH ST #18 THE ORTHOPAEDIC CLINIC P.C.
OPELIKA AL
36801
US

IV. Provider business mailing address

121 NORTH 20TH ST #18 THE ORTHOPAEDIC CLINIC P.C.
OPELIKA AL
36801
US

V. Phone/Fax

Practice location:
  • Phone: 334-749-8303
  • Fax: 334-745-5243
Mailing address:
  • Phone: 334-749-8303
  • Fax: 334-745-5243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5629
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: