Provider Demographics
NPI:1558342931
Name:GODWIN, GEORGE H III (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:H
Last Name:GODWIN
Suffix:III
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 13TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4307
Mailing Address - Country:US
Mailing Address - Phone:256-355-6200
Mailing Address - Fax:256-355-6241
Practice Address - Street 1:1218 13TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4307
Practice Address - Country:US
Practice Address - Phone:256-355-6200
Practice Address - Fax:256-355-6241
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00012876207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL040003243OtherRAILROAD MEDICARE
AL000082160Medicaid
AL051082160OtherPROVIDER NUMBER
AL000082160Medicaid
ALE14401Medicare UPIN