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General NPI Number Information
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NPI Number | 1134176506
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Entity Type | Organization
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Legal Business Name | CHARLES D GODWIN
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 2800 VILLAGE WAY
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City | TRENT WOODS
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State | NC
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Zip | 28562-7305
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Country | US
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Telephone | 252-637-7300
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Fax | 252-637-1772
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Provider Business Mailing Address
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Address Line | 2800 VILLAGE WAY
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City | TRENT WOODS
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State | NC
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Zip | 28562-7305
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Country | US
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Telephone | 252-637-7300
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Fax | 252-637-1772
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MELISSA DIANE FOLK
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Credential |
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Telephone | 252-637-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 33666
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License Number State | NC
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