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General NPI Number Information
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NPI Number | 1144595208
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Entity Type | Organization
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Legal Business Name | DUCKWORTH PATHOLOGY GROUP REFERENCE LAB
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 03/21/2012
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Provider Practice Location Address
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Address Line | 1265 UNION AVE 5TH FLOOR SHERROD WING
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City | MEMPHIS
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State | TN
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Zip | 38104-3415
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Country | US
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Telephone | 901-725-7551
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Fax | 901-725-9721
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Provider Business Mailing Address
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Address Line | 1265 UNION AVE 5TH FLOOR SHERROD WING
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City | MEMPHIS
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State | TN
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Zip | 38104-3415
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Country | US
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Telephone | 901-725-7551
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Fax | 901-725-9721
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS F O'BRIEN
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Credential | MD
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Telephone | 901-725-7551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 3282
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License Number State | TN
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