NPIMap

Organization Active NPI

Gwinnett Pathology Assoc PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Lawrenceville, GA
National Provider Identifier
1104887330
Registry record updated Jun 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
GWINNETT PATHOLOGY ASSOC PC
Practice address
1000 Medical Center Blvd
Pathology Dept
Lawrenceville, GA 30046-7694
Phone
(678) 312-4524
Fax
(770) 682-2219
NPI assigned
Mar 29, 2006
Last updated
Jun 8, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2017

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

Authorized official

Name
Ricardo J Delgado, MDNPI 1467414466
Title
President
Phone
(678) 312-4524

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 Physician 207ZP0102X Primary

Addresses

Primary practice location

1000 Medical Center Blvd
Pathology Dept
Lawrenceville, GA 30046-7694

Mailing address

PO Box 1686
Indianapolis, IN 46206-1686
Phone (706) 232-0156

Other identifiers 1

IdentifierTypeStateIssuer
300030501MedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040527000148 GA Part B Supplier - Clinic/Group Practice 6901887769 Receives reassigned benefits from 9 practitioners
Practice locations: Lawrenceville, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 134

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 134

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496880000000",
    "number": "1104887330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1686",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462061686",
            "telephone_number": "706-232-0156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MEDICAL CENTER BLVD",
            "address_2": "PATHOLOGY DEPT",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300467694",
            "telephone_number": "678-312-4524",
            "fax_number": "770-682-2219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GWINNETT PATHOLOGY ASSOC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2017-06-08",
        "status": "A",
        "authorized_official_last_name": "DELGADO",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-312-4524",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300030501",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.