Provider Demographics
NPI:1477536787
Name:GODWIN, WILLIAM R (RPH, CGP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:GODWIN
Suffix:
Gender:M
Credentials:RPH, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 IRONHILL TRCE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-6758
Mailing Address - Country:US
Mailing Address - Phone:678-494-3983
Mailing Address - Fax:
Practice Address - Street 1:361 IRONHILL TRCE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-6758
Practice Address - Country:US
Practice Address - Phone:678-494-3983
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist