Provider Demographics
NPI:1699072173
Name:GODBEY, JEFFREY TRAVIS (PA-C)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:TRAVIS
Last Name:GODBEY
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5017 SHANNON DR APT 3
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1597
Mailing Address - Country:US
Mailing Address - Phone:304-617-6910
Mailing Address - Fax:
Practice Address - Street 1:5017 SHANNON DR APT 3
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1597
Practice Address - Country:US
Practice Address - Phone:304-617-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant