Provider Demographics
NPI:1194905786
Name:COMMUNITY PATHOLOGY PARTNERS
Entity type:Organization
Organization Name:COMMUNITY PATHOLOGY PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:CARICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-678-1668
Mailing Address - Street 1:PO BOX 2697
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-2697
Mailing Address - Country:US
Mailing Address - Phone:912-678-1668
Mailing Address - Fax:703-991-7215
Practice Address - Street 1:107 N COLLEGE ST
Practice Address - Street 2:D
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5388
Practice Address - Country:US
Practice Address - Phone:912-678-1668
Practice Address - Fax:703-992-7215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory