Provider Demographics
NPI:1770538555
Name:GODFREY D ONIME MD PC
Entity type:Organization
Organization Name:GODFREY D ONIME MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GODFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ONIME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-739-8899
Mailing Address - Street 1:4900 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2110
Mailing Address - Country:US
Mailing Address - Phone:910-739-8899
Mailing Address - Fax:910-739-7174
Practice Address - Street 1:4900 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2110
Practice Address - Country:US
Practice Address - Phone:910-739-8899
Practice Address - Fax:910-739-7174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty