Provider Demographics
NPI:1861460248
Name:PATHOLOGY AND LABORATORY CONSULTANTS OF ATHENS LLC
Entity Type:Organization
Organization Name:PATHOLOGY AND LABORATORY CONSULTANTS OF ATHENS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:706-389-2425
Mailing Address - Street 1:PO BOX 491270
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30049
Mailing Address - Country:US
Mailing Address - Phone:770-237-4500
Mailing Address - Fax:770-237-4539
Practice Address - Street 1:1230 BAXTER ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-389-2425
Practice Address - Fax:770-389-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACN8205OtherRAILROAD MEDICARE
GACN8205OtherRAILROAD MEDICARE