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General NPI Number Information
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NPI Number | 1669546362
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Entity Type | Organization
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Legal Business Name | PATHOLOGY INSTITUTE OF MIDDLE GEORGIA, P.C.
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1606 WATSON BLVD
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City | WARNER ROBINS
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State | GA
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Zip | 31093-3430
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Country | US
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Telephone | 478-929-2001
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Fax | 478-929-4167
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Provider Business Mailing Address
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Address Line | 1606 WATSON BLVD
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City | WARNER ROBINS
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State | GA
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Zip | 31093-3430
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Country | US
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Telephone | 478-929-2001
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES Q. WHITAKER
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Credential | M.D.
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Telephone | 478-929-2001
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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 | 076-008
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License Number State | GA
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