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NPI Code Detail

MEDICARE: HALEIGH BROOK GODWIN

MEDICARE: HALEIGH BROOK GODWIN
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
1106S00000XBehavior TechnicianNC

General Provider Information

NPI Number : 1407794464
Entity Type Code : Individual
Provider Name (Legal Business Name) : HALEIGH BROOK GODWIN
Provider Business Mailing Address
First Line : 4819 EMPEROR BLVD STE 400
Second Line :
City : DURHAM
State : NC
Zip : 27703-5420
Country : US
Telephone Number : 855-832-6727
Fax Number :
Provider Business Practice Location Address
First Line : 4819 EMPEROR BLVD STE 400
Second Line :
City : DURHAM
State : NC
Zip : 27703-5420
Country : US
Telephone Number : 855-832-6727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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Directions to “ HALEIGH BROOK GODWIN ” Practice Location

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