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General NPI Number Information
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NPI Number | 1881666840
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Entity Type | Individual
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Provider Name | GENE GODWIN MD
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Gender | Male
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 2102 W MAIN ST
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City | SALEM
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State | VA
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Zip | 24153-3129
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Country | US
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Telephone | 540-375-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 3716 CHESTERTON ST SW
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City | ROANOKE
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State | VA
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Zip | 24018-1804
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101-017397
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License Number State | VA
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