Provider Demographics
NPI:1356303515
Name:SOUTHERN PATHOLOGY AND LABORATORY SERVICES, PC
Entity Type:Organization
Organization Name:SOUTHERN PATHOLOGY AND LABORATORY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZORNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-931-1320
Mailing Address - Street 1:PO BOX 6626
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-6626
Mailing Address - Country:US
Mailing Address - Phone:229-439-7170
Mailing Address - Fax:229-431-0770
Practice Address - Street 1:126 HWY 280
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31719-8645
Practice Address - Country:US
Practice Address - Phone:229-931-1320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028340207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
511G701169OtherMEDICARE GROUP NUMBER