Provider Demographics
NPI:1093131153
Name:GODWIN, JORDAN (MT-BC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:GODWIN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 SHALLOWFORD RD NE
Mailing Address - Street 2:APT. 3107
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 SHALLOWFORD RD NE
Practice Address - Street 2:APT. 3107
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-1226
Practice Address - Country:US
Practice Address - Phone:770-998-9599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist