Healthcare Provider Details

I. General information

NPI: 1194978122
Provider Name (Legal Business Name): PATHOLOGY GROUP OF LOUISIANA, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5339 ODONOVAN DR
BATON ROUGE LA
70808-4388
US

IV. Provider business mailing address

5339 ODONOVAN DR
BATON ROUGE LA
70808-4388
US

V. Phone/Fax

Practice location:
  • Phone: 225-766-4999
  • Fax: 225-763-5870
Mailing address:
  • Phone: 225-766-4999
  • Fax: 225-764-4702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JANNA M BARKER
Title or Position: CREDENTIALING
Credential:
Phone: 225-706-0513