Provider Demographics
NPI:1841316809
Name:D JOHN GODEHN, JR., M.D., P.A.
Entity type:Organization
Organization Name:D JOHN GODEHN, JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GODEHN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:828-693-0275
Mailing Address - Street 1:506 PARK HILL CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-4265
Mailing Address - Country:US
Mailing Address - Phone:828-693-0275
Mailing Address - Fax:
Practice Address - Street 1:506 PARK HILL CT
Practice Address - Street 2:SUITE 1
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4265
Practice Address - Country:US
Practice Address - Phone:828-693-0275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21561207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8936058Medicaid
NC201830Medicare ID - Type Unspecified
NCC85440Medicare UPIN