Provider Demographics
NPI:1619951332
Name:GODBEY, PATRICK E (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:E
Last Name:GODBEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30309
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29417
Mailing Address - Country:US
Mailing Address - Phone:843-554-9300
Mailing Address - Fax:843-566-8780
Practice Address - Street 1:203 INDIGO DRIVE
Practice Address - Street 2:SOUTHEASTERN PATHOLOGY ASSOCIATES, INC.
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525
Practice Address - Country:US
Practice Address - Phone:912-279-1900
Practice Address - Fax:912-261-0753
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024815207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000293829EMedicaid
GA000293829SMedicaid
GA000293829BMedicaid
GA000293829HMedicaid
GA000293829Medicaid
GA000293829DMedicaid
GA000293829EMedicaid
GA000293829SMedicaid
GA220024330Medicare PIN