Organization
SOUTHEASTERN PATHOLOGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA G BURKHALTER (OFFICE MANAGER)
(706) 314-0120
Entity
Organization
Contact information
Practice address
311 W 8TH ST NE, ROME, GA 30165-2723
(706) 291-8702
(706) 291-6514
Mailing address
311 W 8TH ST NE, ROME, GA 30165-2723
(706) 291-8702
(706) 291-6514
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
11D0256839
GA
207ZD0900X
Dermatopathology (Pathology) Physician
11D0256839
GA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
11D0256839
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
530200720
—
AL
Enumeration date
02/03/2010
Last updated
02/03/2010
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