Provider Demographics
NPI:1972586709
Name:COLUMBUS PATHOLOGY PC
Entity Type:Organization
Organization Name:COLUMBUS PATHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-653-1088
Mailing Address - Street 1:PO BOX 4176
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31914-0176
Mailing Address - Country:US
Mailing Address - Phone:706-653-1088
Mailing Address - Fax:706-653-1162
Practice Address - Street 1:710 CENTER ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1527
Practice Address - Country:US
Practice Address - Phone:706-653-1088
Practice Address - Fax:706-653-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529911720Medicaid
GA300020281AMedicaid
AL529911730Medicaid
AL529701800Medicaid
GA300020281AMedicaid
AL529911720Medicaid
AL529911730Medicaid