Healthcare Provider Details

I. General information

NPI: 1922004852
Provider Name (Legal Business Name): PIEDMONT PATHOLOGY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1899 TATE BLVD SE STE 1105
HICKORY NC
28602-4200
US

IV. Provider business mailing address

1899 TATE BLVD SE STE 1105
HICKORY NC
28602-4200
US

V. Phone/Fax

Practice location:
  • Phone: 828-322-3821
  • Fax: 828-322-6697
Mailing address:
  • Phone: 828-322-3821
  • Fax: 828-322-6697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number21248
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN S MATHIS
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 828-322-3821