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General NPI Number Information
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NPI Number | 1487370581
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Entity Type | Organization
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Legal Business Name | PINEVIEW PATHOLOGY
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Dates
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Enumeration Date | 10/19/2022
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Last Update Date | 01/02/2023
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Provider Practice Location Address
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Address Line | 2501 N PATTERSON ST
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City | VALDOSTA
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State | GA
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Zip | 31602-1735
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Country | US
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Telephone | 229-421-6659
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Fax |
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Provider Business Mailing Address
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Address Line | 109 SWEETBRIAR LAKES DR
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City | THOMASVILLE
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State | GA
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Zip | 31757-0001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOHN PHAM
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Credential | MD
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Telephone | 229-421-6659
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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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