Provider Demographics
NPI:1952073041
Name:COOLEY GEORGE PANTAZIS, MD PA
Entity Type:Organization
Organization Name:COOLEY GEORGE PANTAZIS, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COOLEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:PANTAZIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-831-2402
Mailing Address - Street 1:PO BOX 743170
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3170
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6006 SE ABSHIER BLVD
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-4317
Practice Address - Country:US
Practice Address - Phone:352-368-3443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty