Provider Demographics
NPI:1720016801
Name:SOUTH SUBURBAN PATHOLOGISTS PC
Entity Type:Organization
Organization Name:SOUTH SUBURBAN PATHOLOGISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZOYA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ARBISER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-991-8615
Mailing Address - Street 1:1412 MILSTEAD AVE NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3877
Mailing Address - Country:US
Mailing Address - Phone:678-423-1550
Mailing Address - Fax:678-423-1550
Practice Address - Street 1:141 MILSTEAD AVE NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012
Practice Address - Country:US
Practice Address - Phone:678-423-1550
Practice Address - Fax:678-423-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300026912BMedicaid