MEDICARE: PATHOLOGY CONSULTANTS OF GEORGIA

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	053337	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00046967	OTHER	GA	RAILROAD MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730118498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHOLOGY CONSULTANTS OF GEORGIA

Provider Business Mailing Address
First Line	:	134 ANSLEY DRIVE
Second Line	:	SUITE 500
City	:	DAHLONEGA
State	:	GA
Zip	:	30533-1614
Country	:	US
Telephone Number	:	678-601-6030
Fax Number	:	678-928-9760

Provider Business Practice Location Address
First Line	:	134 ANSLEY DRIVE
Second Line	:	SUITE 500
City	:	DAHLONEGA
State	:	GA
Zip	:	30533-1614
Country	:	US
Telephone Number	:	678-601-6030
Fax Number	:	678-928-9760

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	ARMANDO MONCADA
Credential	:	M.D.
Telephone Number	:	678-601-6030

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	09/17/2014

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