NPIMap

Organization Active NPI

Southeastern Pathology Associates PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Brunswick, GA
National Provider Identifier
1992963268
Registry record updated Nov 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
SOUTHEASTERN PATHOLOGY ASSOCIATES PC
Practice address
203 Indigo Dr
Brunswick, GA 31525-6865
Phone
(912) 261-2669
Fax
(912) 261-0753
NPI assigned
May 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Patrick E Godbey, MD
Title
President
Phone
(912) 261-2669

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0102X Primary

Addresses

Primary practice location

203 Indigo Dr
Brunswick, GA 31525-6865

Mailing address

203 Indigo Dr
Brunswick, GA 31525-6865
Phone (888) 261-2671

Other identifiers 1

IdentifierTypeStateIssuer
197742702BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130606000449 FL Part B Supplier - Clinic/Group Practice 5890781371 Receives reassigned benefits from 32 practitioners
Practice locations: Jacksonville, FL; St Augustine, FL; Orange Park, FL; Jacksonville Beach, FL; Green Cove Springs, FL; Fernandina Beach, FL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

3215 Shrine Rd
Ste 2
Brunswick, GA 31520
Phone (912) 262-0042

710 Center St
Columbus, GA 31901
Phone (706) 571-1000

1000 Business Center Dr
Ste 130
Savannah, GA 31405
Phone (912) 927-9715

900 Mohawk St
Ste C
Savannah, GA 31419
Phone (912) 927-9715

Practitioners & affiliated clinicians

Practitioners 60

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 60

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512000000000",
    "number": "1992963268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 INDIGO DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315256865",
            "telephone_number": "888-261-2671",
            "fax_number": "912-261-0561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 INDIGO DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315256865",
            "telephone_number": "912-261-2669",
            "fax_number": "912-261-0753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN PATHOLOGY ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-23",
        "last_updated": "2017-11-30",
        "status": "A",
        "authorized_official_last_name": "GODBEY",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-261-2669",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197742702B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.