NPIMap

Organization Active NPI

Pathologists Diagnostic Laboratory PA

  • Anatomic Pathology & Clinical Pathology Physician
  • Winston Salem, NC
National Provider Identifier
1003883877
Registry record updated Dec 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
22288 Issued in NC
Legal business name
PATHOLOGISTS DIAGNOSTIC LABORATORY PA
Practice address
1800 S Hawthorne Rd Ste 100
Winston Salem, NC 27103-4014
Phone
(336) 999-8888
Fax
(336) 999-8889
NPI assigned
Mar 1, 2006
Last updated
Dec 12, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2025

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

Authorized official

Name
Dr. Cullen A TaylorNPI 1700852167
Title
President
Phone
(336) 999-8888

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZP0102X 22288 NC Primary

Addresses

Primary practice location

1800 S Hawthorne Rd Ste 100
Winston Salem, NC 27103-4014

Mailing address

PO Box 896315
Charlotte, NC 28289-0369
Phone (336) 999-8888

Other practice location 1

336 Deerfield Rd
Boone, NC 28607-5008
Phone (336) 999-8888

Other practice location 2

373 Glens Blvd.
Banner Elk, NC 28604
Phone (336) 999-8888

Other practice location 3

6835 Manatee Dr
Concord, NC 28025-7416
Phone (336) 999-8888

Other names 1

  • Atlantic Pathology Services PA Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070322000497 NC Part B Supplier - Independent Clinical Laboratory 6002808565 Receives reassigned benefits from 3 practitioners
Practice locations: Concord, NC; Winston Salem, NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D1059373Pathologists Diagnostic Laboratory, PA1800 South Hawthorne Road, Suite 100, Winston-Salem, NC 27103ComplianceJul 11, 2028
34D2267316Pathologists Diagnostic Laboratory, PA6835 Manatee Drive, Concord, NC 28025ComplianceFeb 3, 2027
34D2327315Pathologists Diagnostic Laboratory, PA373 Glens Blvd, Banner Elk, NC 28604RegistrationJul 20, 2027

National Provider Directory

National Provider Directory

Locations

105 W 4th St
Ste 600
Winston Salem, NC 27101
Phone (336) 306-5777

630 Brookwood Business Park Dr
Winston Salem, NC 27105
Phone (336) 999-8888

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765497600000",
    "number": "1003883877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 896315",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282890369",
            "telephone_number": "336-999-8888",
            "fax_number": "369-999-8889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 S HAWTHORNE RD STE 100",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034014",
            "telephone_number": "336-999-8888",
            "fax_number": "336-999-8889"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "336 Deerfield Rd",
            "address_purpose": "LOCATION",
            "city": "Boone",
            "state": "NC",
            "postal_code": "286075008",
            "country_code": "US",
            "telephone_number": "336-999-8888",
            "fax_number": "336-999-8889",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "373 Glens Blvd.",
            "address_purpose": "LOCATION",
            "city": "Banner Elk",
            "state": "NC",
            "postal_code": "28604",
            "country_code": "US",
            "telephone_number": "336-999-8888",
            "fax_number": "369-999-8889",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6835 Manatee Dr",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280257416",
            "country_code": "US",
            "telephone_number": "336-999-8888",
            "fax_number": "336-999-8889",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PATHOLOGISTS DIAGNOSTIC LABORATORY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-01",
        "last_updated": "2025-12-12",
        "certification_date": "2025-12-12",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "CULLEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-999-8888",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NC",
            "license": "22288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atlantic Pathology Services PA",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Atlantic Pathology Services PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.