Provider Demographics
NPI:1568646701
Name:PPG PATHOLOGY AND DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:PPG PATHOLOGY AND DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-384-5718
Mailing Address - Street 1:131 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1206
Mailing Address - Country:US
Mailing Address - Phone:704-384-4814
Mailing Address - Fax:704-384-5770
Practice Address - Street 1:200 HAWTHORNE LANE
Practice Address - Street 2:PRESBYTERIAN PATHOLOGY GROUP
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204
Practice Address - Country:US
Practice Address - Phone:704-384-4814
Practice Address - Fax:704-384-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory