Healthcare Provider Details

I. General information

NPI: 1700189644
Provider Name (Legal Business Name): EAST ALABAMA PATHOLOGISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 E THOMASON CIR
OPELIKA AL
36801-5431
US

IV. Provider business mailing address

503 E THOMASON CIR
OPELIKA AL
36801-5431
US

V. Phone/Fax

Practice location:
  • Phone: 334-749-8234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: KATRIN KLEMM
Title or Position: MEMBER
Credential: M.D.
Phone: 334-528-6968