MEDICARE: ELISE MARSHALL GODLEY

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	363L00000X	Nurse Practitioner	30099	SC

General Provider Information

NPI Number	:	1508684630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE MARSHALL GODLEY

Provider Business Mailing Address
First Line	:	PO BOX 23321
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-4321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2435 FOREST DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2026
Country	:	US
Telephone Number	:	803-409-7170
Fax Number	:

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

Provider Enumeration Date	:	09/27/2024
Last Update Date	:	02/22/2026

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