Provider Demographics
NPI:1326205667
Name:SOUTHEASTERN PATHOLOGY ASSOCIATES INC.
Entity Type:Organization
Organization Name:SOUTHEASTERN PATHOLOGY ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:GODBEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-261-2669
Mailing Address - Street 1:PO BOX 30309
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29417-0309
Mailing Address - Country:US
Mailing Address - Phone:843-554-9300
Mailing Address - Fax:843-566-8780
Practice Address - Street 1:1000 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 130
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-1326
Practice Address - Country:US
Practice Address - Phone:912-927-9715
Practice Address - Fax:912-927-9950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA197742702AMedicaid
GA197742702AMedicaid
GAP00081646Medicare PIN