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General NPI Number Information
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NPI Number | 1841753928
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Entity Type | Individual
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Provider Name | ALEXANDER GODWIN
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Gender | Male
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Dates
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Enumeration Date | 04/07/2019
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Last Update Date | 04/07/2019
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Provider Practice Location Address
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Address Line | 1060 DRAGON RD
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City | OAKWOOD
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State | VA
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Zip | 24631-9210
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Country | US
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Telephone | 866-935-7350
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 451
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City | KEEN MOUNTAIN
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State | VA
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Zip | 24624-0451
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Country | US
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Telephone | 443-640-5748
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 0203018071
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License Number State | VA
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