Provider Demographics
NPI:1568062784
Name:GODWIN, STEPHANIE TERESE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:TERESE
Last Name:GODWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 ASHCRAFT LN
Mailing Address - Street 2:
Mailing Address - City:ATMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36502-4225
Mailing Address - Country:US
Mailing Address - Phone:251-253-1246
Mailing Address - Fax:
Practice Address - Street 1:5850 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-3006
Practice Address - Country:US
Practice Address - Phone:251-368-6245
Practice Address - Fax:251-368-6248
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-102454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily