Provider Demographics
NPI:1922603745
Name:GODEAUX, ERIC ATLAS (NP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ATLAS
Last Name:GODEAUX
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8155 SHENNANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-5201
Mailing Address - Country:US
Mailing Address - Phone:409-791-4909
Mailing Address - Fax:
Practice Address - Street 1:8155 SHENNANDOAH DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-5201
Practice Address - Country:US
Practice Address - Phone:409-791-4909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX944022163W00000X
TX1029611363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse