NPIMap

Organization Active NPI

Southeastern Pathology, P.C.

  • Anatomic Pathology & Clinical Pathology Physician
  • Rome, GA
National Provider Identifier
1508848300
Registry record updated Oct 19, 2026
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
Nov 17, 2005
Last updated
Oct 19, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2026

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 3

IdentifierTypeStateIssuer
11D0256839OtherGACLIA#
11-0291OtherGAUHC PRACTICE PROV#
00067691AMedicaidGA

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://cpiapigateway.cms.gov/api/esmdf/ext/v1/fhir/Practitioner/ Other Management Services Network, LLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040407000313 GA Part B Supplier - Clinic/Group Practice 4183617988 Receives reassigned benefits from 11 practitioners
Practice locations: Rome, GA
O20040710000237 AL Part B Supplier - Clinic/Group Practice 4183617988 Receives reassigned benefits from 3 practitioners
Practice locations: Fort Payne, AL

National Provider Directory

National Provider Directory

Locations

311 W 8th St NE
Rome, GA 30165
Phone (706) 291-2430

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792368000000",
    "number": "1508848300",
    "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": "2005-11-17",
        "last_updated": "2026-10-19",
        "certification_date": "2026-10-19",
        "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": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA#",
            "identifier": "11D0256839",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC PRACTICE PROV#",
            "identifier": "11-0291",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00067691A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://cpiapigateway.cms.gov/api/esmdf/ext/v1/fhir/Practitioner/",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1036.1",
            "affiliationName": "Management Services Network, LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2357 Warm Springs Rd Ste 400",
            "city": "Columbus",
            "state": "GA",
            "country_code": "US",
            "postal_code": "319046874",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Oct 19, 2026; 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.