Provider Demographics
NPI:1538257910
Name:GODWIN, SHEA A (MD)
Entity type:Individual
Prefix:
First Name:SHEA
Middle Name:A
Last Name:GODWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MAIN ST.
Mailing Address - Street 2:SUITE E
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211
Mailing Address - Country:US
Mailing Address - Phone:270-522-6963
Mailing Address - Fax:270-522-7231
Practice Address - Street 1:250 MAIN ST.
Practice Address - Street 2:SUITE E
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211
Practice Address - Country:US
Practice Address - Phone:270-522-6963
Practice Address - Fax:270-522-7231
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41486207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1538257910OtherINDIVIDUAL NPI
KY41486OtherKY LICENSE
1096567OtherUSA MANAGED CARE ORGANIZATION
KY7100013780Medicaid
KY1881852317OtherGROUP NPI