Provider Demographics
NPI:1194011080
Name:EAST TENNESSEE PATHOLOGY, PLLC
Entity Type:Organization
Organization Name:EAST TENNESSEE PATHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:IZABELA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BURJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-586-4231
Mailing Address - Street 1:908 W 4TH NORTH ST
Mailing Address - Street 2:MORRISTOWN-HAMBLEN HOSPITAL
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3894
Mailing Address - Country:US
Mailing Address - Phone:423-586-4231
Mailing Address - Fax:423-585-3388
Practice Address - Street 1:908 W 4TH NORTH ST
Practice Address - Street 2:MORRISTOWN-HAMBLEN HOSPITAL
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3894
Practice Address - Country:US
Practice Address - Phone:423-586-4231
Practice Address - Fax:423-585-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory