MEDICARE: MILSTEAD PATHOLOGY, 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number	:	1235108440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILSTEAD PATHOLOGY, PC

Provider Business Mailing Address
First Line	:	3248 AVALON BLVD
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6320
Country	:	US
Telephone Number	:	770-922-9706
Fax Number	:	770-922-8792

Provider Business Practice Location Address
First Line	:	3248 AVALON BLVD
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6320
Country	:	US
Telephone Number	:	770-922-9706
Fax Number	:	770-922-8792

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SARA GRIFFETH
Credential	:
Telephone Number	:	770-922-9706

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	09/07/2010

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