Provider Demographics
NPI:1497783856
Name:GODWIN, JAMES EDWARD JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:GODWIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3031 NEW BERN AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2989
Mailing Address - Country:US
Mailing Address - Phone:919-231-3966
Mailing Address - Fax:919-231-3912
Practice Address - Street 1:790 SE CARY PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5678
Practice Address - Country:US
Practice Address - Phone:919-231-3966
Practice Address - Fax:919-859-5813
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300705207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8936334Medicaid
NC110162440OtherPALMETTO GBA
NC36335OtherBLUE CROSS BLUE SHIELD
NC36335OtherBLUE CROSS BLUE SHIELD
NC2196875CMedicare ID - Type UnspecifiedMEDICARE #