Provider Demographics
NPI:1750441200
Name:PIEDMONT PATHOLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:PIEDMONT PATHOLOGY ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MCEACHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-400-2430
Mailing Address - Street 1:285 CENTENNIAL OLYMPIC PARK DR NW UNIT 1105
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30313-1845
Mailing Address - Country:US
Mailing Address - Phone:404-561-6014
Mailing Address - Fax:770-254-5097
Practice Address - Street 1:745 POPLAR RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1618
Practice Address - Country:US
Practice Address - Phone:770-400-2430
Practice Address - Fax:770-254-5097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6382Medicare PIN