MEDICARE: CRISTI L GODWIN NP-C

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	363LF0000X	Family Nurse Practitioner	RN130256	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1407824832	OTHER	NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407824832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTI L GODWIN NP-C

Provider Business Mailing Address
First Line	:	1609 NORMAN DR
Second Line	:	STE A-1
City	:	VALDOSTA
State	:	GA
Zip	:	31601-3753
Country	:	US
Telephone Number	:	229-245-1004
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 NORMAN DR
Second Line	:	STE A-1
City	:	VALDOSTA
State	:	GA
Zip	:	31601-3753
Country	:	US
Telephone Number	:	229-245-1004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	01/13/2016

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