Healthcare Provider Details

I. General information

NPI: 1497791420
Provider Name (Legal Business Name): PCA OF COLUMBIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 HATCHER LANE
COLUMBIA TN
38401
US

IV. Provider business mailing address

1602 HATCHER LANE
COLUMBIA TN
38401
US

V. Phone/Fax

Practice location:
  • Phone: 931-490-1000
  • Fax: 931-388-1548
Mailing address:
  • Phone: 931-388-0777
  • Fax: 931-388-1548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number2030
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2030
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number2030
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207ZI0100X
TaxonomyImmunopathology Physician
License Number2030
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number200241
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number2030
License Number StateTN

VIII. Authorized Official

Name: JULIE T ANDREWS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 931-388-0777