Provider Demographics
NPI:1346545118
Name:GODWIN, ANGIE LEIGH (RD LD CSG)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:LEIGH
Last Name:GODWIN
Suffix:
Gender:F
Credentials:RD LD CSG
Other - Prefix:MRS
Other - First Name:ANGIE
Other - Middle Name:GODWIN
Other - Last Name:COFFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD LD CSG
Mailing Address - Street 1:PO BOX 660225
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266-0225
Mailing Address - Country:US
Mailing Address - Phone:205-910-7170
Mailing Address - Fax:205-585-0694
Practice Address - Street 1:709 SHADES CREST RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226-1235
Practice Address - Country:US
Practice Address - Phone:205-910-7170
Practice Address - Fax:205-585-0694
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1169133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered