Provider Demographics
NPI:1295386928
Name:PODPATH, INC
Entity Type:Organization
Organization Name:PODPATH, INC
Other - Org Name:PODPATH SOLUTIONS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:WETHERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-433-0350
Mailing Address - Street 1:1125 TROUPE ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4480
Mailing Address - Country:US
Mailing Address - Phone:067-374-4575
Mailing Address - Fax:
Practice Address - Street 1:2000 LAKE PARK DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7611
Practice Address - Country:US
Practice Address - Phone:678-556-9411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-24
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty