Healthcare Provider Details

I. General information

NPI: 1104893353
Provider Name (Legal Business Name): ATLANTA PATHOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 BOULEVARD NE SUITE 240
ATLANTA GA
30312-1200
US

IV. Provider business mailing address

315 BOULEVARD ST #240
ATLANTA GA
30312
US

V. Phone/Fax

Practice location:
  • Phone: 404-522-0414
  • Fax: 404-521-9254
Mailing address:
  • Phone: 404-522-0414
  • Fax: 404-521-9254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN P BONDELL
Title or Position: DIRECTOR OF THE LAB
Credential: MD
Phone: 404-522-0414