Provider Demographics
NPI:1811584154
Name:PATHPRO LABS LLC.
Entity Type:Organization
Organization Name:PATHPRO LABS LLC.
Other - Org Name:PATHPRO LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF LAB OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADESOKAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-887-2853
Mailing Address - Street 1:1975 N PARK PL SE STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2004
Mailing Address - Country:US
Mailing Address - Phone:678-887-2853
Mailing Address - Fax:855-955-1283
Practice Address - Street 1:1977 N PARK PL SE STE 300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2004
Practice Address - Country:US
Practice Address - Phone:678-887-2853
Practice Address - Fax:855-955-1283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty