Provider Demographics
NPI:1174726996
Name:GODSY, JENNINGS TYSON (MD)
Entity type:Individual
Prefix:
First Name:JENNINGS
Middle Name:TYSON
Last Name:GODSY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11439 SPRING CYPRESS RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-6514
Mailing Address - Country:US
Mailing Address - Phone:281-631-0081
Mailing Address - Fax:281-823-7466
Practice Address - Street 1:11439 SPRING CYPRESS RD
Practice Address - Street 2:UNIT A
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-6514
Practice Address - Country:US
Practice Address - Phone:281-631-0081
Practice Address - Fax:281-823-7466
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN36762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry