Organization
SYNTHESIS PATHOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VINCENT A GIBBERT MD (DIRECTOR)
(478) 464-2600
Entity
Organization
Contact information
Practice address
610 3RD ST, SUITE 206, MACON, GA 31201-3294
(478) 464-2600
(478) 464-2604
Mailing address
610 3RD ST, SUITE 206, MACON, GA 31201-3294
(478) 464-2600
(478) 464-2604
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11D1104616
CLIA
GA
Enumeration date
12/23/2009
Last updated
12/23/2009
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