Provider Demographics
NPI:1093807992
Name:GODWIN, ALAN E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:E
Last Name:GODWIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 OLD HICKORY BLVD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4513
Mailing Address - Country:US
Mailing Address - Phone:615-376-4818
Mailing Address - Fax:615-376-2844
Practice Address - Street 1:761 OLD HICKORY BLVD
Practice Address - Street 2:SUITE #101
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4513
Practice Address - Country:US
Practice Address - Phone:615-376-4818
Practice Address - Fax:615-376-2844
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1475103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3682782Medicare ID - Type UnspecifiedPROVIDER #