Provider Demographics
NPI:1497849533
Name:MIDSOUTH PATHOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:MIDSOUTH PATHOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:H
Authorized Official - Last Name:WHATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-445-9585
Mailing Address - Street 1:105 LOWER WOODVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120
Mailing Address - Country:US
Mailing Address - Phone:601-445-9585
Mailing Address - Fax:601-445-4185
Practice Address - Street 1:105 LOWER WOODVILLE RD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120
Practice Address - Country:US
Practice Address - Phone:601-445-9585
Practice Address - Fax:601-445-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014228Medicaid
MS09014228Medicaid