Provider Demographics
NPI:1043920861
Name:GODFREY, ALPHONSO TAMWIEN
Entity Type:Individual
Prefix:
First Name:ALPHONSO
Middle Name:TAMWIEN
Last Name:GODFREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 AMBER MOOR DR UNIT 203
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-3516
Mailing Address - Country:US
Mailing Address - Phone:614-556-6334
Mailing Address - Fax:
Practice Address - Street 1:75 AMBER MOOR DR UNIT 203
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-3516
Practice Address - Country:US
Practice Address - Phone:614-556-6334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide