Provider Demographics
NPI:1841274768
Name:ACHILIHU, GODFREY (MD FACC)
Entity type:Individual
Prefix:MR
First Name:GODFREY
Middle Name:
Last Name:ACHILIHU
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1711
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71210-1711
Mailing Address - Country:US
Mailing Address - Phone:318-330-9330
Mailing Address - Fax:318-330-9517
Practice Address - Street 1:614 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6236
Practice Address - Country:US
Practice Address - Phone:318-330-9330
Practice Address - Fax:318-330-9517
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11738R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1681903Medicaid
LA1681903Medicaid
F48213Medicare UPIN