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NPI Code Detail

MEDICARE: PATHPRO LABS LLC.

MEDICARE: PATHPRO LABS LLC.
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
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1811584154
Entity Type Code : Organization
Provider Name (Legal Business Name) : PATHPRO LABS LLC.
Provider Business Mailing Address
First Line : 1975 N PARK PL SE STE 300
Second Line :
City : ATLANTA
State : GA
Zip : 30339-2004
Country : US
Telephone Number : 678-887-2853
Fax Number : 855-955-1283
Provider Business Practice Location Address
First Line : 1977 N PARK PL SE STE 300
Second Line :
City : ATLANTA
State : GA
Zip : 30339-2004
Country : US
Telephone Number : 678-887-2853
Fax Number : 855-955-1283
Authorized Official
Title or Position : DIRECTOR OF LAB OPERATIONS
Name : MR. GEORGE ADESOKAN
Credential :
Telephone Number : 678-887-2853
Provider Enumeration Date : 12/21/2020
Last Update Date : 03/25/2022

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Directions to “PATHPRO LABS LLC. ” Practice Location

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