SYNTHESIS PATHOLOGY, LLC (NPI# 1154650091) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154650091 |
| Entity Type | Organization |
| Organization Name | SYNTHESIS PATHOLOGY, LLC |
| Practice Address |
610 3rd St Suite 206 Macon GA 31201-3294 |
| Practice Telephone | 4784642600 |
| Practice Fax Number | 4784642604 |
| Mailing Telephone | 4784642600 |
| Mailing Fax Number | 4784642604 |
| Enumeration Date | 2009-12-23 |
| Last Update Date | 2009-12-23 |
| Authorized Official Name | DR. VINCENT A GIBBERT (DIRECTOR) |
| Authorized Official Telephone | 4784642600 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 291U00000X | Clinical Medical Laboratory | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | CLIA | 11D1104616 | 01 |
| Street Address |
610 3RD ST SUITE 206 |
| City | MACON |
| State | GA |
| Zip Code | 31201-3294 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659362283 | Ellis R Jackson | Nurse Anesthetist, Certified Registered | 610 3rd St, Macon, GA 31201-3294 | 2005-11-02 |
| 1922463132 | Macon Gastroenterology Anesthesia Associates LLC | Anesthesiology | 610 3rd St, Suite 204, Macon, GA 31201-3294 | 2015-12-15 |
| 1275909426 | Kayla Melissa Holloway | Nurse Practitioner | 610 3rd St, Macon, GA 31201-3294 | 2015-08-11 |
| 1942602941 | Your Doctor's After Hours, LLC | Clinic/Center | 610 3rd St, Macon, GA 31201-3294 | 2014-09-22 |
| 1790190817 | Adrienne Kathleen Earl | Nurse Practitioner | 610 3rd St, Suite 202, Macon, GA 31201-3294 | 2014-06-26 |
| 1871861823 | Midstate Anesthesia, LLC | Nurse Anesthetist, Certified Registered | 610 3rd St, Ste 206, Macon, GA 31201-3262 | 2011-12-06 |
| 1194000489 | Lauren Mathews Dykes | Nurse Practitioner | 610 3rd St, Suite 204, Macon, GA 31201-3294 | 2011-10-18 |
| 1578886941 | Jessica G Kosmowski | Nurse Anesthetist, Certified Registered | 610 3rd St, Suite 206, Macon, GA 31201-3294 | 2010-03-12 |
| 1437381480 | Sarah Pittard Hobbs | Nurse Practitioner | 610 3rd St, Suite 204, Macon, GA 31201-3294 | 2009-08-10 |
| 1811174964 | Eclipse Anesthesia LLC | Nurse Anesthetist, Certified Registered | 610 3rd St, Ste 206, Macon, GA 31201-3294 | 2008-01-30 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639666340 | Yasameen Emad Muzahim | Internal Medicine | 777 Hemlock Street, Msc 165, Macon, GA 31201 | 2018-04-18 |
| 1952819419 | Putnam Dialysis LLC | Clinic/Center | 657 Hemlock Street, Suite 200, Macon, GA 31201 | 2018-01-18 |
| 1730604331 | Graham Arthur Mercier | Surgery | 169 Ashley Ave., Room 202 Main Hospital Msc 333, Charleston, SC 31201 | 2017-08-04 |
| 1376075705 | Diamond Jude | Internal Medicine | 777 Hemlock Street Msc #104, Macon, GA 31201 | 2017-04-03 |
| 1174055263 | Carol Roobin Bashuk | Hearing Instrument Specialist | 634 First Street, Macon, GA 31201 | 2017-03-29 |
| 1144752411 | Hubert Pare | Student in an Organized Health Care Education/Training Program | 777 Hemlock Street, Msc# 165, Macon, GA 31201 | 2017-03-28 |
| 1548613789 | Michael Daugherty | Counselor | 1873 Hardeman Ave, Suite 1, Macon, GA 31201 | 2016-07-22 |
| 1316317993 | 4front Healthcare of Middle Georgia, LLC | Hospice Care, Community Based | 682 1st St, Macon, GA 31201 | 2015-09-25 |
| 1881073054 | Andrew Lee Drahos | Surgery | 777 Hemlock St # 140, Macon, GA 31201 | 2015-05-21 |
| 1720474158 | April Nicole Colley | Nurse Practitioner | 1014 Forsyth Street, Macon, GA 31201 | 2015-04-13 |
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| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
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| 1255473906 | Macon Clinical Laboratory, Inc. | Clinical Medical Laboratory | 602 Njefferson Street, Macon, MS 39341 | 2007-02-12 |
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| 1528125648 | Infinity Laboratory | Clinical Medical Laboratory | 841 Mulberry St, Macon, GA 31201-6756 | 2007-01-02 |
| 1528127586 | Atlantic Sleep Lab, Inc. | Clinical Medical Laboratory | 560 First Street, Macon, GA 31201 | 2006-12-06 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.