Organization
SOUTHEASTERN CLINICAL LABORATORIES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES ROBERT PRUITT M.D. (PRESIDENT)
(706) 282-4245
Entity
Organization
Contact information
Practice address
2003 FALLS RD, TOCCOA, GA 30577-9700
(706) 282-4245
Mailing address
PO BOX 52990, GREENWOOD, SC 29649-0048
(864) 223-3600
(864) 223-6054
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
4472
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA6065
—
SC
Enumeration date
04/12/2006
Last updated
04/17/2008
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