Organization
HEALTHSOURCE MEDICAL CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CRISTI LEIGH GODWIN NP-C (PRESIDENT)
(229) 245-1004
Entity
Organization
Contact information
Practice address
1609 NORMAN DR, STE A-1, VALDOSTA, GA 31601-3753
(229) 245-1004
(229) 245-1074
Mailing address
1609 NORMAN DR, STE A-1, VALDOSTA, GA 31601-3753
(229) 245-1004
(229) 245-1074
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN130256
GA
Other
Enumeration date
12/27/2010
Last updated
01/13/2016
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