Provider Demographics
NPI:1578955068
Name:GODFREY, CHRISTOPHER (CSA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:GODFREY
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 SW 52ND ST
Mailing Address - Street 2:APT 119
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6837
Mailing Address - Country:US
Mailing Address - Phone:301-233-7245
Mailing Address - Fax:
Practice Address - Street 1:610 SW 52ND ST
Practice Address - Street 2:APT 119
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6837
Practice Address - Country:US
Practice Address - Phone:301-233-7245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant