Healthcare Provider Details

I. General information

NPI: 1720549595
Provider Name (Legal Business Name): KRISTEN SUZICH GODWIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN LYNN SUZICH MD

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 N UNIVERSITY PKWY
HIGH POINT NC
27262-7613
US

IV. Provider business mailing address

1565 N UNIVERSITY PKWY
HIGH POINT NC
27262-7613
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2020
  • Fax: 336-802-2021
Mailing address:
  • Phone: 336-802-2020
  • Fax: 336-802-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2023-00437
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: