Individual
LORIEN T ALTADONNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
705 DIXIE ST, CARROLLTON, GA 30117-3818
(770) 836-9672
(770) 838-8827
Mailing address
705 DIXIE STREET, WEST GEORGIA PATHOLOGY, LLC AT TANNER MEDICAL CENTER, CARROLLTON, GA 30117-3818
(770) 836-9672
(770) 838-8827
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
MD.28629
GA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD.28629
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021221829
MEDICARE
GA
05
—
218387735A
—
GA
Enumeration date
11/16/2007
Last updated
09/30/2021
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