Provider Demographics
NPI:1750302303
Name:TRI-COUNTY PATHOLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:TRI-COUNTY PATHOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:FINGERLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-424-7800
Mailing Address - Street 1:PO BOX 60280
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29419-0280
Mailing Address - Country:US
Mailing Address - Phone:843-569-4020
Mailing Address - Fax:770-237-4980
Practice Address - Street 1:833 CAMPBELL HILL ST NW
Practice Address - Street 2:SUITE 111
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1134
Practice Address - Country:US
Practice Address - Phone:770-424-7800
Practice Address - Fax:770-426-8572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZP0102X
GA193400000X291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00061652AMedicaid
GA246800OtherBLUE CROSS/BLUE SHIELD
GA00061652AMedicaid
GA=========AMedicare PIN