Organization
SOUTHEASTERN PATHOLOGY ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD DEWITT JOHNSON MD (PRESIDENT SPA PA)
(910) 671-5189
Entity
Organization
Contact information
Practice address
300 W 27TH STREET, LUMBERTON, NC 28359
(910) 671-5189
(910) 671-5085
Mailing address
PO BOX 847, LUMBERTON, NC 28359
(910) 738-1921
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
9300163
NC
291U00000X
Clinical Medical Laboratory
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02710
BLUE CROSS BLUE SHIELD
NC
05
—
8902710
—
NC
Enumeration date
05/08/2006
Last updated
09/06/2007
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