Individual
CAROLYN KINZER-BEZANSON WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
203 INDIGO DRIVE, SOUTHEASTERN PATHOLOGY ASSOCIATES, PC, BRUNSWICK, GA 31525
(912) 279-1900
(912) 261-0753
Mailing address
PO BOX 30309, CHARLESTON, SC 29417
(843) 554-9300
(843) 566-8780
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
038275
GA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
MD.12093R/INACTIVE
LA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
MD29387
SC
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
MD317652
AL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
ME85489
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000931356
—
GA
05
—
000931356A
—
GA
05
—
000931356B
—
GA
05
—
000931356C
—
GA
05
—
000931356D
—
GA
05
—
000931356E
—
GA
05
—
000931356F
—
GA
05
—
000931356I
—
GA
Enumeration date
12/06/2005
Last updated
12/05/2014
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