Provider Demographics
NPI:1669546362
Name:PATHOLOGY INSTITUTE OF MIDDLE GEORGIA, P.C.
Entity type:Organization
Organization Name:PATHOLOGY INSTITUTE OF MIDDLE GEORGIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:Q
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-929-2001
Mailing Address - Street 1:1606 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3430
Mailing Address - Country:US
Mailing Address - Phone:478-929-2001
Mailing Address - Fax:
Practice Address - Street 1:1606 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3430
Practice Address - Country:US
Practice Address - Phone:478-929-2001
Practice Address - Fax:478-929-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA076-008291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA69WBDKQMedicare ID - Type Unspecified