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Organization

EASTSIDE PATHOLOGY PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
EDWIN W NUNNERY MD (PRESIDENT)
(770) 979-0200
Entity
Organization

Contact information

Practice address
1700 MEDICAL WAY, PATHOLOGY DEPT, SNELLVILLE, GA 30078
(770) 979-0200
Mailing address
PO BOX 1457, BLUEFIELD, WV 24701-1457

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300033615A
GA
01
CN5006
RAILROAD MEDICARE
Enumeration date
09/25/2006
Last updated
09/29/2009
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