Provider Demographics
NPI:1538311907
Name:ATLANTA PATHOLOGY PA
Entity type:Organization
Organization Name:ATLANTA PATHOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-522-0414
Mailing Address - Street 1:PO BOX 491239
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30049-0058
Mailing Address - Country:US
Mailing Address - Phone:800-887-7338
Mailing Address - Fax:
Practice Address - Street 1:315 BOULEVARD STREET
Practice Address - Street 2:240
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312
Practice Address - Country:US
Practice Address - Phone:404-522-0414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00002219A1Medicaid
GA00042OtherBLUE CROSS BLUE SHIELD
GA65012069LAMedicare PIN