Provider Demographics
NPI:1225098551
Name:TIFTON PATHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:TIFTON PATHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:W
Authorized Official - Last Name:BEIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-353-7535
Mailing Address - Street 1:PO BOX 7442
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-7442
Mailing Address - Country:US
Mailing Address - Phone:229-353-7535
Mailing Address - Fax:
Practice Address - Street 1:907 18TH ST E
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3643
Practice Address - Country:US
Practice Address - Phone:229-353-7535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20344291U00000X
GA035467291U00000X
GA044378291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300023175AMedicaid
GA300023175AMedicaid