Golden Triangle Pathology

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

Legal business name

GOLDEN TRIANGLE PATHOLOGY

Practice address

2520 5TH St N
Columbus, MS 39705-2008

Phone

(800) 362-0858

Fax

(662) 534-7188

NPI assigned

Oct 27, 2011

Organization subpart

No

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

Authorized official

Name

Dr. John P Fullenwider, M.D.

Title

Owner

Phone

(800) 362-0858

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1319673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415318400000",
    "number": "1760768329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2906",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386552925",
            "telephone_number": "800-362-0858",
            "fax_number": "662-534-7188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 5TH ST N",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397052008",
            "telephone_number": "800-362-0858",
            "fax_number": "662-534-7188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN TRIANGLE PATHOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-27",
        "last_updated": "2014-11-07",
        "status": "A",
        "authorized_official_last_name": "FULLENWIDER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "800-362-0858",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02622338",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DS3144",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lillian Ainsworth Glusenkamp, R.D.
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• Golden Triangle Neurology Clinic, PLLC
• Golden Triangle Periodontal Center
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• Golden Triangle Radiology, PA
• Golden Triangle Urology PLLC
• Golden Years Adult Daycare

• Anatomic Pathology & Clinical Pathology Physician in Columbus, MS
• Providers in Columbus, MS by specialty
• Anatomic Pathology & Clinical Pathology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2014; 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.