Provider Demographics
NPI:1073637740
Name:ALBANY PATHOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:ALBANY PATHOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARROLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-439-7170
Mailing Address - Street 1:PO BOX 71385
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-1385
Mailing Address - Country:US
Mailing Address - Phone:229-439-7170
Mailing Address - Fax:229-431-0770
Practice Address - Street 1:1907 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1574
Practice Address - Country:US
Practice Address - Phone:229-439-7170
Practice Address - Fax:229-431-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047-015291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55002162Medicaid
GACL8506OtherRR MEDICARE
GACL8506OtherRR MEDICARE