Provider Demographics
NPI:1831136787
Name:GODWIN, SUSAN KAYE (ANP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAYE
Last Name:GODWIN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-0655
Mailing Address - Country:US
Mailing Address - Phone:731-925-2300
Mailing Address - Fax:731-925-2157
Practice Address - Street 1:207 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:TN
Practice Address - Zip Code:38425-5547
Practice Address - Country:US
Practice Address - Phone:931-676-3121
Practice Address - Fax:731-925-2157
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7564363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3907880Medicaid
TN4138126OtherBCBS TN
TN3907880Medicaid
TNS47892Medicare UPIN