Healthcare Provider Details

I. General information

NPI: 1396243630
Provider Name (Legal Business Name): BAKOTIC PATHOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 SHILOH RD
ALPHARETTA GA
30005-8347
US

IV. Provider business mailing address

6240 SHILOH RD
ALPHARETTA GA
30005-8347
US

V. Phone/Fax

Practice location:
  • Phone: 855-245-2256
  • Fax: 770-292-9331
Mailing address:
  • Phone: 855-245-2256
  • Fax: 770-292-9331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT BAKOTIC
Title or Position: CFO
Credential:
Phone: 678-965-2822