Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 23192 | SC |
NPI | 1003806266 |
---|---|
Provider Name | Dr. Terry Anthony Godfrey |
First Address | Atlanta, GA 30374-3904 |
Second Address | Sumter, SC 29150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 06/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
231920 | (05) | SC |