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NPI Code Detail

MEDICARE: NTX PATHOLOGY PROGRAM, PLLC

MEDICARE: NTX PATHOLOGY PROGRAM, PLLC
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number : 1770352957
Entity Type Code : Organization
Provider Name (Legal Business Name) : NTX PATHOLOGY PROGRAM, PLLC
Provider Business Mailing Address
First Line : PO BOX 745390
Second Line :
City : ATLANTA
State : GA
Zip : 30374-5390
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3101 N TARRANT PKWY
Second Line :
City : FORT WORTH
State : TX
Zip : 76177-8656
Country : US
Telephone Number : 817-639-1180
Fax Number :
Authorized Official
Title or Position : CHIEF OPERATIONS OFFICER
Name : MICHAEL JAMAINE DAVIS
Credential :
Telephone Number : 561-402-4256
Provider Enumeration Date : 12/28/2023
Last Update Date : 12/28/2023

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