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General NPI Number Information
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NPI Number | 1831236652
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Entity Type | Organization
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Legal Business Name | PATH LAB OF MIDDLE TENNESSEE
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 08/10/2009
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Provider Practice Location Address
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Address Line | 400 N HIGHLAND AVE
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City | MURFREESBORO
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State | TN
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Zip | 37130-3837
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Country | US
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Telephone | 615-396-4489
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1069
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City | MADISON
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State | TN
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Zip | 37116-1069
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Country | US
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Telephone | 615-868-1266
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Fax | 615-868-1316
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | RICHARD D MICHAELSON
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Credential | M.D.
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Telephone | 615-396-4489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25282
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License Number State | TN
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