Provider Demographics
NPI:1215178058
Name:GASTROINTESTINAL SPECIALISTS OF GEORGIA HISTOLOGY
Entity Type:Organization
Organization Name:GASTROINTESTINAL SPECIALISTS OF GEORGIA HISTOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:O'ROURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-739-9555
Mailing Address - Street 1:2550 WINDY HILL RD SE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 HIGHLANDS PKWY SE
Practice Address - Street 2:SUITE 430
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5166
Practice Address - Country:US
Practice Address - Phone:770-739-9555
Practice Address - Fax:770-941-2109
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GASTROINTESTINAL SPECIALISTS OF GEORGIA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-06
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory