Provider Demographics
NPI:1144072273
Name:KING-GODINEAUX, DAISY MELINDA (FNP)
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:MELINDA
Last Name:KING-GODINEAUX
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DAISY
Other - Middle Name:MELINDA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:2103 RIVER WALK CT
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-3205
Mailing Address - Country:US
Mailing Address - Phone:678-464-4636
Mailing Address - Fax:
Practice Address - Street 1:4760 AUSTELL RD STE 1&3
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-2007
Practice Address - Country:US
Practice Address - Phone:678-464-4636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN129544163W00000X, 163WC0400X, 163WH0500X, 163WD1100X, 163WG0000X, 163WH0200X, 363LF0000X, 163WN0300X, 163WP0000X, 363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
No163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WN0300XNursing Service ProvidersRegistered NurseNephrology
No163WP0000XNursing Service ProvidersRegistered NursePain Management