Provider Demographics
NPI:1831931161
Name:GODSEY, JAJUAN
Entity type:Individual
Prefix:MR
First Name:JAJUAN
Middle Name:
Last Name:GODSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7196 SEA BREEZE DR E APT 103
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-8085
Mailing Address - Country:US
Mailing Address - Phone:567-371-1038
Mailing Address - Fax:
Practice Address - Street 1:7196 SEA BREEZE DR E APT 103
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-8085
Practice Address - Country:US
Practice Address - Phone:567-371-1038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator