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1821104704

NPI Code Detail

MEDICARE: SOUTHEASTERN PATHOLOGY ASSOCIATES PC

MEDICARE: SOUTHEASTERN PATHOLOGY ASSOCIATES PC

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	291U00000X	Clinical Medical Laboratory	063012	GA
2	291U00000X	Clinical Medical Laboratory	800015943	FL
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

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	04485	OTHER	GA	BSGA GROUP
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	38374	OTHER	FL	BSFL GROUP

General Provider Information

NPI Number	:	1821104704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEASTERN PATHOLOGY ASSOCIATES PC

Provider Business Mailing Address
First Line	:	203 INDIGO DR
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31525-6865
Country	:	US
Telephone Number	:	912-261-2669
Fax Number	:	912-261-0561

Provider Business Practice Location Address
First Line	:	203 INDIGO DR
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31525-6865
Country	:	US
Telephone Number	:	912-261-2669
Fax Number	:	912-261-0753

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PATRICK E GODBEY
Credential	:	M.D.
Telephone Number	:	912-261-2669

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	10/26/2021

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Directions to “SOUTHEASTERN PATHOLOGY ASSOCIATES PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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