NPIMap

Organization Active NPI

Southeastern Pathology, P.C.

  • Anatomic Pathology & Clinical Pathology Physician
  • Rome, GA
National Provider Identifier
1407188345
Registry record updated Feb 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
11D0256839 Issued in GA
Legal business name
SOUTHEASTERN PATHOLOGY, P.C.
Practice address
311 W 8TH St NE
Rome, GA 30165-2723
Phone
(706) 291-8702
Fax
(706) 291-6514
NPI assigned
Feb 3, 2010
Last updated
Feb 3, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2010

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

Authorized official

Name
Tina G Burkhalter
Title
Office Manager
Phone
(706) 314-0120

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology Physician 207ZC0500X 11D0256839 GA
Dermatopathology (Pathology) Physician 207ZD0900X 11D0256839 GA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 11D0256839 GA Primary

Addresses

Primary practice location

311 W 8TH St NE
Rome, GA 30165-2723

Mailing address

311 W 8TH St NE
Rome, GA 30165-2723
Phone (706) 291-8702

Other identifiers 1

IdentifierTypeStateIssuer
530200720MedicaidAL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1265155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265155200000",
    "number": "1407188345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 W 8TH ST NE",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301652723",
            "telephone_number": "706-291-8702",
            "fax_number": "706-291-6514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 W 8TH ST NE",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301652723",
            "telephone_number": "706-291-8702",
            "fax_number": "706-291-6514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN PATHOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-03",
        "last_updated": "2010-02-03",
        "status": "A",
        "authorized_official_last_name": "BURKHALTER",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "706-314-0120"
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "GA",
            "license": "11D0256839",
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "GA",
            "license": "11D0256839",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "GA",
            "license": "11D0256839",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "530200720",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rome, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2010; 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.