Basic Information
| Provider Information | |||||||||
| NPI: | 1194011080 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST TENNESSEE PATHOLOGY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 908 W 4TH NORTH ST | ||||||||
| Address2: | MORRISTOWN-HAMBLEN HOSPITAL | ||||||||
| City: | MORRISTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378143894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235864231 | ||||||||
| FaxNumber: | 4235853388 | ||||||||
| Practice Location | |||||||||
| Address1: | 908 W 4TH NORTH ST | ||||||||
| Address2: | MORRISTOWN-HAMBLEN HOSPITAL | ||||||||
| City: | MORRISTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378143894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235864231 | ||||||||
| FaxNumber: | 4235853388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2011 | ||||||||
| LastUpdateDate: | 06/20/2011 | ||||||||
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| AuthorizedOfficialLastName: | BURJA | ||||||||
| AuthorizedOfficialFirstName: | IZABELA | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 4235864231 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.