Provider Demographics
NPI:1578960456
Name:PATHOLOGY CONSULTANTS OF AUGUSTA, P.C.
Entity Type:Organization
Organization Name:PATHOLOGY CONSULTANTS OF AUGUSTA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:DOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-731-5831
Mailing Address - Street 1:3540 WHEELER RD
Mailing Address - Street 2:SUITE 617
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1871
Mailing Address - Country:US
Mailing Address - Phone:706-731-5831
Mailing Address - Fax:706-731-5831
Practice Address - Street 1:3540 WHEELER RD
Practice Address - Street 2:SUITE 617
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1871
Practice Address - Country:US
Practice Address - Phone:706-731-5831
Practice Address - Fax:706-731-5831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11D2087298OtherCLIA