Provider Demographics
NPI:1770213282
Name:GODWIN PSYCHIATRY P.A.
Entity type:Organization
Organization Name:GODWIN PSYCHIATRY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-587-4051
Mailing Address - Street 1:2719 GRAVES DRIVE #19
Mailing Address - Street 2:#19
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4536
Mailing Address - Country:US
Mailing Address - Phone:919-587-4051
Mailing Address - Fax:919-580-1083
Practice Address - Street 1:2719 GRAVES DRIVE #19
Practice Address - Street 2:#19
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4536
Practice Address - Country:US
Practice Address - Phone:919-587-4051
Practice Address - Fax:919-580-1083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC270174OtherNORTH CAROLINA MEDICAL BOARD
NC5913116Medicaid