Healthcare Provider Details

I. General information

NPI: 1073637740
Provider Name (Legal Business Name): ALBANY PATHOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 PALMYRA RD
ALBANY GA
31701-1574
US

IV. Provider business mailing address

PO BOX 71385
ALBANY GA
31708-1385
US

V. Phone/Fax

Practice location:
  • Phone: 229-439-7170
  • Fax: 229-431-0770
Mailing address:
  • Phone: 229-439-7170
  • Fax: 229-431-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number047-015
License Number StateGA

VIII. Authorized Official

Name: CHRISTINA HARROLD
Title or Position: OFFICE MANAGER
Credential:
Phone: 229-439-7170