Organization
LDC DERMATOPATHOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN D COOPER MD (OWNER/PRESIDENT)
(614) 273-5705
Entity
Organization
Contact information
Practice address
4343 SHALLOWFORD RD, SUITE B3B, MARIETTA, GA 30062-5023
(614) 273-5705
(678) 742-8486
Mailing address
4343 SHALLOWFORD RD, SUITE B3B, MARIETTA, GA 30062-5023
(614) 273-5705
(678) 742-8486
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
61056
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
APPLYING FOR
—
GA
Enumeration date
05/15/2013
Last updated
05/15/2013
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