Provider Demographics
NPI:1184665861
Name:GODFRIN, GEORGES P (NP)
Entity Type:Individual
Prefix:
First Name:GEORGES
Middle Name:P
Last Name:GODFRIN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 MONTAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-1942
Mailing Address - Country:US
Mailing Address - Phone:864-223-1468
Mailing Address - Fax:
Practice Address - Street 1:516 MONTAGUE AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-1942
Practice Address - Country:US
Practice Address - Phone:864-223-1468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 1662363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S74394Medicare UPIN
SCS743947511Medicare ID - Type Unspecified