Healthcare Provider Details

I. General information

NPI: 1750302303
Provider Name (Legal Business Name): TRI-COUNTY PATHOLOGY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CAMPBELL HILL ST NW SUITE 111
MARIETTA GA
30060-1134
US

IV. Provider business mailing address

PO BOX 60280
CHARLESTON SC
29419-0280
US

V. Phone/Fax

Practice location:
  • Phone: 770-424-7800
  • Fax: 770-426-8572
Mailing address:
  • Phone: 843-569-4020
  • Fax: 770-237-4980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number193400000X
License Number StateGA

VIII. Authorized Official

Name: DR. RICHARD ERNEST FINGERLE
Title or Position: CHAIRMAN
Credential: M.D.
Phone: 770-424-7800