Healthcare Provider Details

I. General information

NPI: 1790650695
Provider Name (Legal Business Name): MARTRINO DENISE GODLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 FLOYD AVE
NORTH AUGUSTA SC
29841-4276
US

IV. Provider business mailing address

1922 HEATHERS CT
AUGUSTA GA
30906-8124
US

V. Phone/Fax

Practice location:
  • Phone: 803-426-8071
  • Fax: 803-426-8144
Mailing address:
  • Phone: 706-373-4454
  • Fax: 803-426-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN206284
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: