Basic Information
| Provider Information | |||||||||
| NPI: | 1730240995 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEASE PATHOLOGY ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 198317 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303848317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277346635 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 MAIN ST | ||||||||
| Address2: | MS417 | ||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346985848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277346635 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 05/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7277346635 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Legal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 260651800 | 05 | FL | MEDICAID |