MEDICARE: PATRICK E GODBEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	024815	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619951332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK E GODBEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 30309
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29417
Country	:	US
Telephone Number	:	843-554-9300
Fax Number	:	843-566-8780

Provider Business Practice Location Address
First Line	:	203 INDIGO DRIVE
Second Line	:	SOUTHEASTERN PATHOLOGY ASSOCIATES, INC.
City	:	BRUNSWICK
State	:	GA
Zip	:	31525
Country	:	US
Telephone Number	:	912-279-1900
Fax Number	:	912-261-0753

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	12/10/2010

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