Provider Demographics
NPI:1316907850
Name:GODBEY, ASA LAWRENCE JR (MD)
Entity type:Individual
Prefix:
First Name:ASA
Middle Name:LAWRENCE
Last Name:GODBEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2830 NW 41ST ST
Mailing Address - Street 2:STE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6667
Mailing Address - Country:US
Mailing Address - Phone:352-372-0387
Mailing Address - Fax:352-372-0387
Practice Address - Street 1:2830 NW 41ST ST
Practice Address - Street 2:STE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6667
Practice Address - Country:US
Practice Address - Phone:352-372-0387
Practice Address - Fax:352-372-0387
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2009-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME00111522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
01826ZMedicare PIN
D50223Medicare UPIN