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Organization

SOUTHEASTERN PATHOLOGY ASSOCIATES PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. PATRICK E GODBEY M.D. (PRESIDENT)
(912) 261-2669
Entity
Organization

Contact information

Practice address
203 INDIGO DR, BRUNSWICK, GA 31525-6865
(912) 261-2669
(912) 261-0753
Mailing address
203 INDIGO DR, BRUNSWICK, GA 31525-6865
(912) 261-2669
(912) 261-0561

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
291U00000X
Clinical Medical Laboratory
063012
GA
291U00000X
Clinical Medical Laboratory
800015943
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
030703300
FL
05
030707600
FL
05
031806000
FL
01
04485
BSGA GROUP
GA
05
197742702A
GA
05
197742702B
GA
01
38374
BSFL GROUP
FL
Enumeration date
08/22/2006
Last updated
10/26/2021
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