Basic Information
| Provider Information | |||||||||
| NPI: | 1174820971 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WATAUGA PATHOLOGY ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1725 W MARKET ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234311310 | ||||||||
| FaxNumber: | 4234316331 | ||||||||
| Practice Location | |||||||||
| Address1: | 1725 W MARKET ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234311310 | ||||||||
| FaxNumber: | 4234316331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2011 | ||||||||
| LastUpdateDate: | 02/15/2011 | ||||||||
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| AuthorizedOfficialLastName: | SOIKE | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4234311310 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | TN | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.