1346545118 NPI number — MRS. ANGIE LEIGH GODWIN RD LD CSG

Table of content: MRS. ANGIE LEIGH GODWIN RD LD CSG (NPI 1346545118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346545118 NPI number — MRS. ANGIE LEIGH GODWIN RD LD CSG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GODWIN
Provider First Name:
ANGIE
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD LD CSG
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COFFIELD
Provider Other First Name:
ANGIE
Provider Other Middle Name:
GODWIN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD LD CSG
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1346545118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 660225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35266-0225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-910-7170
Provider Business Mailing Address Fax Number:
205-585-0694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
709 SHADES CREST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35226-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-910-7170
Provider Business Practice Location Address Fax Number:
205-585-0694
Provider Enumeration Date:
01/25/2011

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: 133V00000X , with the licence number:  1169 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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