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General NPI Number Information
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NPI Number | 1295103364
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Entity Type | Organization
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Legal Business Name | MICHELLE M GODFREY PA
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Dates
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Enumeration Date | 09/08/2015
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Last Update Date | 09/08/2015
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Provider Practice Location Address
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Address Line | 901 BURNETT DR
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-2908
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Country | US
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Telephone | 870-424-4935
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 305
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City | MOUNTAIN HOME
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State | AR
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Zip | 72654-0305
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Country | US
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Telephone | 870-405-0382
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHELLE GODFREY
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Credential | DO
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Telephone | 870-405-0382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | E-2846
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License Number State | AR
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