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General NPI Number Information
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NPI Number | 1437724879
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Entity Type | Organization
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Legal Business Name | ACCESS DERMPATH, INC.
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 1415 ALICE ST
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City | WAYCROSS
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State | GA
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Zip | 31501-4528
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Country | US
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Telephone | 352-536-9270
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Fax |
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Provider Business Mailing Address
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Address Line | 3705 S HIGHWAY 27 STE 201
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City | CLERMONT
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State | FL
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Zip | 34711-7950
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Country | US
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Telephone | 352-241-6280
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | VICKI TILTON
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Credential |
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Telephone | 352-241-6280
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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 |
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License Number State |
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