West Georgia Pathology, LLC

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

Legal business name

WEST GEORGIA PATHOLOGY, LLC

Practice address

705 Dixie St
Attention: Pathology Department
Carrollton, GA 30117-3818

Phone

(678) 305-9046

NPI assigned

Aug 1, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael C Grattendick

Title

Vice President

Phone

(561) 626-5512

Specialties & licenses 1

Addresses

Other names 1

• WGP Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435795200000",
    "number": "1003823196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11025 RCA CENTER DR",
            "address_2": "SUITE 300",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334104269",
            "telephone_number": "561-514-5822",
            "fax_number": "561-626-4530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 DIXIE ST",
            "address_2": "ATTENTION: PATHOLOGY DEPARTMENT",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173818",
            "telephone_number": "678-305-9046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST GEORGIA PATHOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2015-07-02",
        "status": "A",
        "authorized_official_last_name": "GRATTENDICK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "561-626-5512"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WGP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Anatomic Pathology & Clinical Pathology Physician in Carrollton, GA
• Providers in Carrollton, GA by specialty
• Anatomic Pathology & Clinical Pathology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.