Provider Demographics
NPI:1164487492
Name:GODETTE, GEORGE AUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:AUSTIN
Last Name:GODETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MACTANLY PL
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2373
Mailing Address - Country:US
Mailing Address - Phone:540-885-1281
Mailing Address - Fax:540-213-2208
Practice Address - Street 1:108 MACTANLY PL
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2373
Practice Address - Country:US
Practice Address - Phone:540-885-1281
Practice Address - Fax:540-213-2208
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049732174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006410057Medicaid
VAF85081Medicare UPIN