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General NPI Number Information
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NPI Number | 1538368501
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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 | 07/11/2007
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 1777 MONTREAL CIR STE A-C
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City | TUCKER
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State | GA
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Zip | 30084-6802
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Country | US
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Telephone | 678-406-1289
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Fax | 770-621-7530
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Provider Business Mailing Address
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Address Line | 14275 MIDWAY RD SUITE 400
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City | ADDISON
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State | TX
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Zip | 75001-3614
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Country | US
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Telephone | 214-932-8029
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Fax | 610-271-4245
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | KRISTIE M DOLAN
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Credential |
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Telephone | 866-697-8378
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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 | 11D1066992
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License Number State | GA
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