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Organization
EASTSIDE PATHOLOGY PC
Active
Organization
EASTSIDE PATHOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWIN W NUNNERY MD (PRESIDENT)
(770) 979-0200
Entity
Organization
Contact information
Practice address
1700 MEDICAL WAY, PATHOLOGY DEPT, SNELLVILLE, GA 30078
(770) 979-0200
Mailing address
PO BOX 1457, BLUEFIELD, WV 24701-1457
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300033615A
—
GA
01
—
CN5006
RAILROAD MEDICARE
—
Enumeration date
09/25/2006
Last updated
09/29/2009
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