Individual
DR. RAE JEANNA GODSEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2100 MARKET ST, STE 100, CHARLESTOWN, IN 47111-9535
(812) 256-0700
(812) 256-0704
Mailing address
1502 TUNNEL MILL RD, CHARLESTOWN, IN 47111-9216
(812) 256-0700
(812) 256-0704
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02002615A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000301780
ANTHEM
—
01
—
02002615A
STATE LICENSE
IN
01
—
1209485
CHA HEALTH
IN
01
—
15D1020413
CLIA
—
05
—
200441850A
—
IN
05
—
64079213
—
KY
01
—
7022469
AETNA
—
01
—
907008
USA MCO
—
Enumeration date
06/24/2005
Last updated
03/07/2023
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