Provider Demographics
NPI:1922207786
Name:CSI PATHOLOGY LLC
Entity Type:Organization
Organization Name:CSI PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAFARY
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:800-990-9185
Mailing Address - Street 1:11525 PARK WOODS CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2422
Mailing Address - Country:US
Mailing Address - Phone:800-990-9185
Mailing Address - Fax:678-205-4901
Practice Address - Street 1:11525 PARK WOODS CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2422
Practice Address - Country:US
Practice Address - Phone:800-990-9185
Practice Address - Fax:678-205-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory