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General NPI Number Information
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NPI Number | 1164669388
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Entity Type | Organization
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Legal Business Name | TRI COUNTY PATHOLOGY ASSOCIATES LAB
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Dates
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Enumeration Date | 01/09/2009
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 833 CAMPBELL HILL ST NW SUITE 111
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City | MARIETTA
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State | GA
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Zip | 30060-1134
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Country | US
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Telephone | 770-424-7800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 60280
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City | CHARLESTON
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State | SC
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Zip | 29419-0280
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Country | US
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Telephone | 770-424-7800
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HANY BISHARA
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Credential | MD
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Telephone | 770-424-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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