Healthcare Provider Details

I. General information

NPI: 1326596644
Provider Name (Legal Business Name): MACY GODMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

UK DIVISION OF DIGESTIVE DISEASES 800 ROSE ST, MN 649
LEXINGTON KY
40536-0298
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-1000
  • Fax:
Mailing address:
  • Phone: 859-323-4887
  • Fax: 859-257-2605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2141
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: