Provider Demographics
NPI:1497755649
Name:FINAN DERMATOPATHOLOGY LABORATORY, P.C.
Entity Type:Organization
Organization Name:FINAN DERMATOPATHOLOGY LABORATORY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:FINAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-851-1766
Mailing Address - Street 1:1200 LAKE HEARN DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4408
Mailing Address - Country:US
Mailing Address - Phone:404-851-1766
Mailing Address - Fax:404-851-1767
Practice Address - Street 1:1200 LAKE HEARN DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4408
Practice Address - Country:US
Practice Address - Phone:404-851-1766
Practice Address - Fax:404-851-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-201291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN1953OtherRR MEDICARE
GA416841123AMedicaid
GA69WBDJLMedicare PIN