Provider Demographics
NPI:1083044465
Name:DERMATOPATHOLOGY LAB OF SKIN CANCER SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:DERMATOPATHOLOGY LAB OF SKIN CANCER SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHASTAIN, M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-422-5557
Mailing Address - Street 1:175 WHITE STREET
Mailing Address - Street 2:SUITE 175
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1054
Mailing Address - Country:US
Mailing Address - Phone:770-422-5557
Mailing Address - Fax:770-422-8816
Practice Address - Street 1:175 WHITE STREET
Practice Address - Street 2:SUITE 370
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1054
Practice Address - Country:US
Practice Address - Phone:770-422-5557
Practice Address - Fax:770-422-8816
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKIN CANCER SPECIALISTS P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory