MEDICARE: ATLANTA DERMATOPATHOLOGY & PATHOLOGY ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	031-018	GA

General Provider Information

NPI Number	:	1699753913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA DERMATOPATHOLOGY & PATHOLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	1800 PHOENIX BLVD
Second Line	:	SUITE 210
City	:	ATLANTA
State	:	GA
Zip	:	30349-5593
Country	:	US
Telephone Number	:	770-994-1360
Fax Number	:	770-994-1264

Provider Business Practice Location Address
First Line	:	1800 PHOENIX BLVD
Second Line	:	SUITE 210
City	:	ATLANTA
State	:	GA
Zip	:	30349-5593
Country	:	US
Telephone Number	:	770-994-1360
Fax Number	:	770-994-1264

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS R WADE
Credential	:	M.D.
Telephone Number	:	770-994-1360

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	08/22/2020

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