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General NPI Number Information
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NPI Number | 1104690460
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Entity Type | Individual
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Provider Name | MR. JAMES MATTHEW GODWIN IV
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Gender | Male
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 830 EZZARD CHARLES DR
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City | CINCINNATI
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State | OH
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Zip | 45214-2525
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Country | US
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Telephone | 513-381-6672
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Fax |
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Provider Business Mailing Address
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Address Line | 508 ELBERON AVE
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City | CINCINNATI
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State | OH
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Zip | 45205-2302
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Country | US
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Telephone | 304-952-1507
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 004433
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License Number State | OH
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