Provider Demographics
NPI:1235101965
Name:PIEDMONT PATHOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:PIEDMONT PATHOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DODDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-779-4858
Mailing Address - Street 1:404 E CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5803
Mailing Address - Country:US
Mailing Address - Phone:800-779-4858
Mailing Address - Fax:864-231-6448
Practice Address - Street 1:404 E CALHOUN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5803
Practice Address - Country:US
Practice Address - Phone:800-779-4858
Practice Address - Fax:864-231-8227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10667207ZB0001X, 207ZF0201X
SC14206207ZD0900X
SC7122207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion MedicineGroup - Single Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA0980Medicaid
NC8902417Medicaid
SCCE5208Medicare PIN
SC1556Medicare PIN