Provider Demographics
NPI:1740517416
Name:PATHMEDIC LLC
Entity type:Organization
Organization Name:PATHMEDIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSELYNE
Authorized Official - Middle Name:O
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-679-9348
Mailing Address - Street 1:903 HONEY CREEK RD SE # B
Mailing Address - Street 2:SUITE 275
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-2801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2055 GEES MILL RD NE
Practice Address - Street 2:SUITE 326
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1362
Practice Address - Country:US
Practice Address - Phone:770-679-9348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA122-R-0608251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health