NPIMap

Organization Active NPI

Pathology Associates of Waycross

  • Anatomic Pathology & Clinical Pathology Physician
  • Waycross, GA
National Provider Identifier
1861486904
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
PATHOLOGY ASSOCIATES OF WAYCROSS
Practice address
410 Darling Ave
Waycross, GA 31501-5246
Phone
(912) 287-1515
Fax
(912) 287-1394
NPI assigned
Sep 5, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dwight P Mirmow, MDNPI 1730173493
Title
President
Phone
(912) 287-1515

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 PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X GA Primary

Addresses

Primary practice location

410 Darling Ave
Waycross, GA 31501-5246

Mailing address

PO Box 1409
Waycross, GA 31502-1409
Phone (706) 287-1515

National Provider Directory

National Provider Directory

Locations

300 Pineview Dr
Waycross, GA 31501
Phone (912) 283-5470

Practitioners & affiliated clinicians

Practitioners 4

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": "1125878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1861486904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1409",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315021409",
            "telephone_number": "706-287-1515",
            "fax_number": "912-287-1394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 DARLING AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315015246",
            "telephone_number": "912-287-1515",
            "fax_number": "912-287-1394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHOLOGY ASSOCIATES OF WAYCROSS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-05",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MIRMOW",
        "authorized_official_first_name": "DWIGHT",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-287-1515",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waycross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.