Basic Information
| Provider Information | |||||||||
| NPI: | 1619951332 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GODBEY | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 30309 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435549300 | ||||||||
| FaxNumber: | 8435668780 | ||||||||
| Practice Location | |||||||||
| Address1: | 203 INDIGO DRIVE | ||||||||
| Address2: | SOUTHEASTERN PATHOLOGY ASSOCIATES, INC. | ||||||||
| City: | BRUNSWICK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122791900 | ||||||||
| FaxNumber: | 9122610753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 12/10/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 024815 | GA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 000293829E | 05 | GA | MEDICAID | 000293829S | 05 | GA | MEDICAID | 000293829B | 05 | GA | MEDICAID | 000293829H | 05 | GA | MEDICAID | 000293829 | 05 | GA | MEDICAID | 000293829D | 05 | GA | MEDICAID |