Provider Demographics
NPI:1346638970
Name:JOANNE GODLEY MD INC
Entity Type:Organization
Organization Name:JOANNE GODLEY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GODLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-805-6521
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96733-6595
Mailing Address - Country:US
Mailing Address - Phone:215-805-6521
Mailing Address - Fax:
Practice Address - Street 1:39 W KAMEHAMEHA AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2263
Practice Address - Country:US
Practice Address - Phone:808-877-2424
Practice Address - Fax:808-877-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14526207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty