Healthcare Provider Details

I. General information

NPI: 1134176506
Provider Name (Legal Business Name): CHARLES D GODWIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 VILLAGE WAY
TRENT WOODS NC
28562-7305
US

IV. Provider business mailing address

2800 VILLAGE WAY
TRENT WOODS NC
28562-7305
US

V. Phone/Fax

Practice location:
  • Phone: 252-637-7300
  • Fax: 252-637-1772
Mailing address:
  • Phone: 252-637-7300
  • Fax: 252-637-1772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number33666
License Number StateNC

VIII. Authorized Official

Name: MRS. MELISSA DIANE FOLK
Title or Position: OFFICE MANAGER
Credential:
Phone: 252-637-7300