MEDICARE: AARON GODWIN MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	58475	GA

General Provider Information

NPI Number	:	1255614723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AARON GODWIN MD LLC

Provider Business Mailing Address
First Line	:	658 KENNESAW AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2711
Country	:	US
Telephone Number	:	404-580-9200
Fax Number	:	678-593-4900

Provider Business Practice Location Address
First Line	:	658 KENNESAW AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2711
Country	:	US
Telephone Number	:	404-580-9200
Fax Number	:	678-593-4900

Authorized Official
Title or Position	:	DOCTOR
Name	:	AARON O GODWIN
Credential	:
Telephone Number	:	404-580-9200

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	09/26/2011

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