Provider Demographics
NPI:1760656318
Name:PATHMEDIC
Entity Type:Organization
Organization Name:PATHMEDIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:T
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-931-5540
Mailing Address - Street 1:3011 HERITAGE PL NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-7206
Mailing Address - Country:US
Mailing Address - Phone:478-804-0008
Mailing Address - Fax:478-804-0009
Practice Address - Street 1:3011 HERITAGE PL NE
Practice Address - Street 2:SUITE B
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7206
Practice Address - Country:US
Practice Address - Phone:478-804-0008
Practice Address - Fax:478-804-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)