Individual
RONNIE LEE GODBOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
204 W HILL BLVD, CHARLESTON AFB, SC 29404-4704
(843) 963-6936
(843) 963-6903
Mailing address
204 W HILL BLVD, CHARLESTON AFB, SC 29404-4704
(843) 963-6936
(843) 963-6903
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
06/23/2009
Last updated
06/23/2009
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