Provider Demographics
NPI:1063603892
Name:GODWIN, JENNIFER E (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:GODWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 EATON DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-4094
Mailing Address - Country:US
Mailing Address - Phone:330-620-2283
Mailing Address - Fax:
Practice Address - Street 1:400 MATTHEW ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1644
Practice Address - Country:US
Practice Address - Phone:740-373-4111
Practice Address - Fax:740-373-4860
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.094288207V00000X
MEMD26005207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3055330Medicaid
OH35.094288OtherSTATE MEDICAL LICENSE