LDC Dermatopathology, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

61056 Issued in GA

Legal business name

LDC DERMATOPATHOLOGY, LLC

Practice address

4343 Shallowford Rd
Suite B3B
Marietta, GA 30062-5023

Phone

(614) 273-5705

Fax

(678) 742-8486

NPI assigned

May 15, 2013

Organization subpart

No

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

Authorized official

Name

Lynn D Cooper, MD

Title

Owner/President

Phone

(614) 273-5705

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1368576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368576000000",
    "number": "1114363207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4343 SHALLOWFORD RD",
            "address_2": "SUITE B3B",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300625023",
            "telephone_number": "614-273-5705",
            "fax_number": "678-742-8486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4343 SHALLOWFORD RD",
            "address_2": "SUITE B3B",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300625023",
            "telephone_number": "614-273-5705",
            "fax_number": "678-742-8486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LDC DERMATOPATHOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-15",
        "last_updated": "2013-05-15",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "614-273-5705",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "GA",
            "license": "61056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "APPLYING FOR",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valerie Elisabeth Lawton-Edwards, LPC
• Grayson Seth Layton
• Thaddeus James Layton, D.C.
• Roxana Yamileht Lazo Gonzalez, MD
• Desiree H Lazzara, D.C
• Le Yuan Aesthetic LLC
• Hannah Le-Nguyen, MD
• Anh Le, MD
• Stacey May Le
• Tiffany Le, FNP

• Clinical Medical Laboratory in Marietta, GA
• Providers in Marietta, GA by specialty
• Clinical Medical Laboratory in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2013; 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.