Healthcare Provider Details

I. General information

NPI: 1013495290
Provider Name (Legal Business Name): GODWIN MEDICAL GROUP, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SENECA ST
VENTURA CA
93001-1411
US

IV. Provider business mailing address

801 SENECA ST
VENTURA CA
93001-1411
US

V. Phone/Fax

Practice location:
  • Phone: 404-580-9200
  • Fax:
Mailing address:
  • Phone: 404-580-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number156851
License Number StateCA

VIII. Authorized Official

Name: AARON OREE GODWIN
Title or Position: CEO
Credential: MD
Phone: 404-580-9200