Organization
GA CELL AND TISSUE DIAGNOSTIC CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HARRY STATON LATHAM M.D. (PRESIDENT)
(229) 273-4956
Entity
Organization
Contact information
Practice address
902 N 7TH ST, CORDELE, GA 31015-3234
(229) 276-3342
Mailing address
PO BOX 568, CORDELE, GA 31010-0568
(229) 273-4956
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
032934
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000532111B
—
GA
01
—
DG5747
RAILROAD MEDICARE
GA
Enumeration date
08/31/2006
Last updated
01/30/2012
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