Provider Demographics
NPI:1659571792
Name:GODWIN, MEREDITH OWEN (MD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:OWEN
Last Name:GODWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2719 GRAVES DR. #19
Mailing Address - Street 2:#19
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4536
Mailing Address - Country:US
Mailing Address - Phone:919-587-4051
Mailing Address - Fax:919-580-1083
Practice Address - Street 1:2719 GRAVES DR. #19
Practice Address - Street 2:#19
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4536
Practice Address - Country:US
Practice Address - Phone:919-587-4051
Practice Address - Fax:919-580-1083
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-015062084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913116Medicaid
NC2075159Medicare PIN