Healthcare Provider Details

I. General information

NPI: 1760995682
Provider Name (Legal Business Name): EMILY ELIZABETH GODWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 JOHN DODD RD
WELLFORD SC
29385-9744
US

IV. Provider business mailing address

21 BADGER DR
TAYLORS SC
29687-5505
US

V. Phone/Fax

Practice location:
  • Phone: 864-249-3532
  • Fax:
Mailing address:
  • Phone: 864-787-2876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: