Individual
THOMAS DALE GODFREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
GNP
Contact information
Practice address
1005 GROVE RD, GREENVILLE, SC 29605-4630
(864) 455-6900
(864) 255-5619
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
18871
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP2851
—
SC
Enumeration date
06/18/2014
Last updated
06/11/2021
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