Healthcare Provider Details

I. General information

NPI: 1063603892
Provider Name (Legal Business Name): JENNIFER E GODWIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MATTHEW ST
MARIETTA OH
45750-1644
US

IV. Provider business mailing address

1136 EATON DR
AKRON OH
44312-4094
US

V. Phone/Fax

Practice location:
  • Phone: 740-373-4111
  • Fax: 740-373-4860
Mailing address:
  • Phone: 330-620-2283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.094288
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD26005
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: