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General NPI Number Information
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NPI Number | 1174516108
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PATHOLOGY ASSOCIATES
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 150 REYNOIR ST
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City | BILOXI
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State | MS
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Zip | 39530-4130
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Country | US
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Telephone | 228-432-1571
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Fax | 228-436-1256
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Provider Business Mailing Address
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Address Line | 5700 SOUTHWYCK BLVD
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City | TOLEDO
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State | OH
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Zip | 43614-1509
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Country | US
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Telephone | 800-288-8325
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Fax |
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Authorized Official
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Title or Position | HEAD PHYSICIAN
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Name | JOHN NELSON
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Credential | MD
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Telephone | 228-432-1571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine 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 | 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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