1801951231 NPI number — DR. JAMES CLEMENT GODFREY III M.D.

Table of content: DR. JAMES CLEMENT GODFREY III M.D. (NPI 1801951231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801951231 NPI number — DR. JAMES CLEMENT GODFREY III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GODFREY
Provider First Name:
JAMES
Provider Middle Name:
CLEMENT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801951231
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4322 HARDING PIKE
Provider Second Line Business Mailing Address:
SUITE 229
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37205-2490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-385-1451
Provider Business Mailing Address Fax Number:
615-298-4257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4322 HARDING PIKE
Provider Second Line Business Practice Location Address:
SUITE 229
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37205-2490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-385-1451
Provider Business Practice Location Address Fax Number:
615-298-4257
Provider Enumeration Date:
12/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD38499 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3892479 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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