Provider Demographics
NPI:1811485923
Name:GODFREY, CAROLINE MARIE
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MARIE
Last Name:GODFREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER NORTH SUITE CCC-4312
Mailing Address - Street 2:1161 21ST AVE SOUTH
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-2730
Mailing Address - Country:US
Mailing Address - Phone:615-875-9968
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER NORTH SUITE CCC-4312
Practice Address - Street 2:1161 21ST AVE SOUTH
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-2730
Practice Address - Country:US
Practice Address - Phone:615-875-9968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program