MEDICARE: STEPHEN A. GODLEWSKI MD PC

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	152W00000X	Optometrist	OPT001255	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316166598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN A. GODLEWSKI MD PC

Provider Business Mailing Address
First Line	:	2085 MCGEE RD
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-2910
Country	:	US
Telephone Number	:	770-979-1144
Fax Number	:	770-736-1480

Provider Business Practice Location Address
First Line	:	3370 SUGARLOAF PKWY
Second Line	:	SUITE B-3
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-5478
Country	:	US
Telephone Number	:	770-339-9100
Fax Number	:	770-339-9090

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DEBBIE ZIER
Credential	:
Telephone Number	:	770-979-1144

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/22/2020

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