Basic Information
| Provider Information | |||||||||
| NPI: | 1952528648 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINNACLE PATHOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 56020 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722156020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012277688 | ||||||||
| FaxNumber: | 5012252930 | ||||||||
| Practice Location | |||||||||
| Address1: | 8908 KANIS RD | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722056414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012277688 | ||||||||
| FaxNumber: | 5012252930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 12/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | ALONZO | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5012277688 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.