MEDICARE: PATHOLOGIC DIAGNOSTIC LLC

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	246QL0900X	Laboratory Management Specialist/Technologist

General Provider Information

NPI Number	:	1962371450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHOLOGIC DIAGNOSTIC LLC

Provider Business Mailing Address
First Line	:	219 W BRYAN ST STE 200
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31401-2542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1261 RIBAUT ROAD
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29902
Country	:	US
Telephone Number	:	843-783-2273
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	PRISCILLA JONES
Credential	:
Telephone Number	:	912-755-9941

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	03/13/2026

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Directions to “PATHOLOGIC DIAGNOSTIC LLC ” Practice Location

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