Provider Demographics
NPI:1841236965
Name:DOMM, ALBERT C (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:C
Last Name:DOMM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1602 HATCHER LANE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401
Mailing Address - Country:US
Mailing Address - Phone:931-388-0777
Mailing Address - Fax:931-388-1548
Practice Address - Street 1:1602 HATCHER LANE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-388-0777
Practice Address - Fax:931-388-1548
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN35822207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology