Provider Demographics
NPI:1275858524
Name:BAKOTIC PATHOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BAKOTIC PATHOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKOTIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-376-7284
Mailing Address - Street 1:PO BOX 740209
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0209
Mailing Address - Country:US
Mailing Address - Phone:855-245-2256
Mailing Address - Fax:770-292-9331
Practice Address - Street 1:6240 SHILOH RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-8347
Practice Address - Country:US
Practice Address - Phone:855-245-2256
Practice Address - Fax:770-292-9331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-339207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty