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General NPI Number Information
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NPI Number | 1467502716
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Entity Type | Organization
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Legal Business Name | OCMULGEE MEDICAL PATHOLOGY ASSOCIATION INC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 350 HOSPITAL DR
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City | MACON
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State | GA
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Zip | 31217-3838
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Country | US
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Telephone | 478-765-4865
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Fax |
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Provider Business Mailing Address
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Address Line | 2560 N SHADELAND AVE STE A ATTN: ANN PATTERSON
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-1706
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Country | US
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Telephone | 317-275-8072
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Fax | 317-275-8124
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Authorized Official
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Title or Position | VP
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Name | MR. EDWARD M KRAMER
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Credential | M.D.
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Telephone | 317-275-8072
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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 | 11D0982593
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License Number State | GA
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