Provider Demographics
NPI:1164496592
Name:GODWIN, CHARLES DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DONALD
Last Name:GODWIN
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 1:2800 VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:TRENT WOODS
Mailing Address - State:NC
Mailing Address - Zip Code:28562-7305
Mailing Address - Country:US
Mailing Address - Phone:252-637-3000
Mailing Address - Fax:252-637-1771
Practice Address - Street 1:2800 VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:TRENT WOODS
Practice Address - State:NC
Practice Address - Zip Code:28562-7305
Practice Address - Country:US
Practice Address - Phone:252-637-7300
Practice Address - Fax:252-637-1771
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC336662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8936034Medicaid
NC36034OtherBC BS
NC213573AMedicare ID - Type Unspecified
NC8936034Medicaid