Provider Demographics
NPI:1740262161
Name:GODFREY, JOSEPH L (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L
Last Name:GODFREY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:100 GLENWAY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3114
Mailing Address - Country:US
Mailing Address - Phone:704-825-2599
Mailing Address - Fax:704-825-2597
Practice Address - Street 1:100 GLENWAY ST
Practice Address - Street 2:SUITE A
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3114
Practice Address - Country:US
Practice Address - Phone:704-825-2599
Practice Address - Fax:704-825-2597
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-20
Last Update Date:2017-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC98002552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1740262161Medicaid
SCN00255Medicaid
NC1740262161Medicaid