Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207ZB0001X | Pathology | Blood Banking & Transfusion Medicine | 026841 | GEORGIA | No |
| 2 | 207ZP0102X | Pathology | Anatomic Pathology & Clinical Pathology | 026841 | GEORGIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 52235375 007 | OTHER | GEORGIA | BCBS MACON NORTHSIDE |
| 2 | 52235375 008 | OTHER | GEORGIA | BCBS BLECKLEY |
| 3 | 52235375 009 | OTHER | GEORGIA | BCBS MARIETTA |
| 4 | 202I220225 | MEDICAID | GEORGIA | |
| 5 | 000302112A | MEDICAID | GEORGIA | |
| 6 | 220014937 | MEDICARE PIN | GEORGIA | |
| 7 | 345972 | OTHER | GEORGIA | WELLCARE |
| 8 | 581267100 | OTHER | GEORGIA | TRICARE |
| 9 | 22CDBFR | MEDICARE PIN | | |
| 10 | 52235375 005 | OTHER | GEORGIA | BCBS COLISEUM |
| 11 | 52235375 006 | OTHER | GEORGIA | BCBS MONROE |
| 12 | D39603 | MEDICARE UPIN | GEORGIA | |
