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Organization
SOUTHEASTERN PATHOLOGY ASSOCIATES PA
Active
Organization
SOUTHEASTERN PATHOLOGY ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD DEWITT JOHNSON MD (PRESIDENT SPA PA)
(910) 671-5189
Entity
Organization
Contact information
Practice address
300 W 27TH STREET, LUMBERTON, NC 28359
(910) 671-5189
(910) 671-5085
Mailing address
PO BOX 847, LUMBERTON, NC 28359
(910) 738-1921
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
9300163
NC
291U00000X
Clinical Medical Laboratory
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02710
BLUE CROSS BLUE SHIELD
NC
05
—
8902710
—
NC
Enumeration date
05/08/2006
Last updated
09/06/2007
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