Healthcare Provider Details

I. General information

NPI: 1720053945
Provider Name (Legal Business Name): WATAUGA PATHOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 02/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N STATE OF FRANKLIN RD
JOHNSON CITY TN
37604-6035
US

IV. Provider business mailing address

PO BOX 52990
GREENWOOD SC
29649-0048
US

V. Phone/Fax

Practice location:
  • Phone: 423-431-6388
  • Fax: 423-431-6331
Mailing address:
  • Phone: 864-223-3600
  • Fax: 864-223-6054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberMD0000020115
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD0000015437
License Number StateTN

VIII. Authorized Official

Name: DR. DAVID RICHARD SOIKE
Title or Position: PRESIDENT
Credential: MD
Phone: 423-431-6388