Provider Demographics
NPI:1033926233
Name:GODWIN, ELIZABETH DUPREE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DUPREE
Last Name:GODWIN
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 1:3678 N UNION RD
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:GA
Mailing Address - Zip Code:31637-3502
Mailing Address - Country:US
Mailing Address - Phone:229-507-6557
Mailing Address - Fax:
Practice Address - Street 1:3678 N UNION RD
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:GA
Practice Address - Zip Code:31637-3502
Practice Address - Country:US
Practice Address - Phone:229-507-6557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor