| NPI | 1508848300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA G BURKHALTER Office Manager 706-314-0120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: GA 11D0256839) |
| Additional Taxonomies | 207ZC0500X Pathology Cytopathology (Licence: GA 11D0256839) |
| 207ZD0900X Pathology Dermatopathology (Licence: GA 11D0256839) | |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2010-01-14 |