Provider Demographics
NPI:1053958181
Name:GODWIN, GAIL KATHERINE (PHD, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:KATHERINE
Last Name:GODWIN
Suffix:
Gender:F
Credentials:PHD, PMHNP-BC
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 78
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31059-0078
Mailing Address - Country:US
Mailing Address - Phone:470-522-9270
Mailing Address - Fax:
Practice Address - Street 1:2927 DEMERE RD
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS IS
Practice Address - State:GA
Practice Address - Zip Code:31522-1620
Practice Address - Country:US
Practice Address - Phone:912-638-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN069333363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health