Provider Demographics
NPI:1821075185
Name:GODOY, GISELLA E (MD)
Entity Type:Individual
Prefix:DR
First Name:GISELLA
Middle Name:E
Last Name:GODOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:SC
Mailing Address - Zip Code:29138-1313
Mailing Address - Country:US
Mailing Address - Phone:864-445-2250
Mailing Address - Fax:864-445-7332
Practice Address - Street 1:501 W BUTLER AVE
Practice Address - Street 2:
Practice Address - City:SALUDA
Practice Address - State:SC
Practice Address - Zip Code:29138-1313
Practice Address - Country:US
Practice Address - Phone:864-445-2250
Practice Address - Fax:864-445-7332
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3767Medicaid
SCGP3767Medicaid