Provider Demographics
NPI:1013656602
Name:DIAGNOSTIC TISSUE/CYTOLOGY GROUP, PLLC
Entity Type:Organization
Organization Name:DIAGNOSTIC TISSUE/CYTOLOGY GROUP, PLLC
Other - Org Name:DIAGNOSTIC TISSUE/CYTOLOGY GROUP, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-483-8300
Mailing Address - Street 1:PO BOX 3780
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-3780
Mailing Address - Country:US
Mailing Address - Phone:318-841-9500
Mailing Address - Fax:318-841-9551
Practice Address - Street 1:1512 20TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4124
Practice Address - Country:US
Practice Address - Phone:601-483-8300
Practice Address - Fax:601-484-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty