Carolyn Kinzer Bezanson Wall (NPI# 1124002712, PAC ID# 5698804169) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PATHOLOGY.
| Nation Provider ID (NPI) | 1124002712 |
| PAC ID by PECOS | 5698804169 |
| Professional Enrollment ID | I20100520000777 |
| Full Name | Carolyn Kinzer Bezanson Wall |
| Organization Legal Name | SOUTHEASTERN PATHOLOGY ASSOCIATES PC |
| Address |
801 W Gordon St Thomaston GA 30286-3426 |
| Phone Number | 9122612669 |
| Gender | F |
| Medical School | MEDICAL COLLEGE OF GEORGIA |
| Graduation Year | 1992 |
| Primary Specialty | PATHOLOGY |
| Group Practice PAC ID | 5890781371 |
| Number of Group Practice Members | 46 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 110128 | MEADOWS REGIONAL MEDICAL CENTER |
| 110124 | WAYNE MEMORIAL HOSPITAL |
| 110089 | COFFEE REGIONAL MEDICAL CENTER |
| 110025 | SOUTHEAST GEORGIA HEALTH SYSTEM- BRUNSWICK CAMPUS |
| 110150 | NAVICENT HEALTH BALDWIN |
| Address | Phone | Organization |
|---|---|---|
| 2415 Parkwood Dr, Brunswick, GA 31520-4722 | 9124667000 | SOUTHEASTERN PATHOLOGY ASSOCIATES PC |
| 1101 Ocilla Rd, Douglas, GA 31533-2207 | 9123841900 | SOUTHEASTERN PATHOLOGY ASSOCIATES PC |
| 801 Oak St, Green Cove Springs, FL 32043-4317 | 9042849230 | SOUTHEASTERN PATHOLOGY ASSOCIATES PC |
| 865 S 1st St, Jesup, GA 31545-0210 | 9124276811 | SOUTHEASTERN PATHOLOGY ASSOCIATES PC |
| 821 N Cobb St, Milledgeville, GA 31061-2343 | 4784543551 | SOUTHEASTERN PATHOLOGY ASSOCIATES PC |
| 2000 Dan Proctor Dr, Saint Marys, GA 31558-3810 | 9125766200 | SOUTHEASTERN PATHOLOGY ASSOCIATES PC |
| 459 Ga Hwy 119 S, Springfield, GA 31329-3021 | 91226126691205 | SOUTHEASTERN PATHOLOGY ASSOCIATES PC |
| 801 W Gordon St, Thomaston, GA 30286-3426 | 9122612669 | SOUTHEASTERN PATHOLOGY ASSOCIATES PC |
| 1 Meadows Pkwy, Vidalia, GA 30474-8759 | 91226126691205 | SOUTHEASTERN PATHOLOGY ASSOCIATES PC |
| 1601 Watson Blvd, Warner Robins, GA 31093-3431 | 4783225155 | SOUTHEASTERN PATHOLOGY ASSOCIATES PC |
| Organization Legal Name | SOUTHEASTERN PATHOLOGY ASSOCIATES PC |
| Physicians | 49 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Yumi Angerica Kojima | Pathology | Southeastern Pathology Associates PC | 203 Indigo Dr, Brunswick, GA 31525-6865 |
| Janet O Hon | Pathology | Southeastern Pathology Associates PC | 801 Oak St, Green Cove Springs, FL 32043-4317 |
| Ningxing Chen | Pathology | Southeastern Pathology Associates PC | 801 W Gordon St, Thomaston, GA 30286-3426 |
| David A Holloman | Pathology | Southeastern Pathology Associates PC | 800 Prudential Dr, Jacksonville, FL 32207-8202 |
| James H Hudson | Pathology | Southeastern Pathology Associates PC | 203 Indigo Dr, Brunswick, GA 31525-6865 |
| Shyamala Yennam | Pathology | Southeastern Pathology Associates PC | 2415 Parkwood Dr, Brunswick, GA 31520-4722 |
| Tatiana Vasylievna Barsukova | Pathology | Southeastern Pathology Associates PC | 800 Prudential Dr, Jacksonville, FL 32207-8202 |
| Gerson Paull | Pathology | Southeastern Pathology Associates PC | 801 W Gordon St, Thomaston, GA 30286-3426 |
| Thuy L Penedo | Pathology | Southeastern Pathology Associates PC | 800 Prudential Dr, Jacksonville, FL 32207-8202 |
| Robert K Wade | Pathology | Southeastern Pathology Associates PC | 1499 Fair Rd, Statesboro, GA 30458-1683 |
| Street Address |
801 W GORDON ST |
| City | THOMASTON |
| State | GA |
| Zip | 30286-3426 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Ningxing Chen | Pathology | Southeastern Pathology Associates PC | 801 W Gordon St, Thomaston, GA 30286-3426 |
| Tammie Ann Williams | Nurse Practitioner | Hightower Physician Services, PC | 801 W Gordon St, Thomaston, GA 30286-3426 |
| Alan B Miller | Emergency Medicine | Hightower Emergency Group PC | 801 W Gordon St, Thomaston, GA 30286-3426 |
| Salih O Faldon | Family Medicine | Hightower Emergency Group PC | 801 W Gordon St, Thomaston, GA 30286-3426 |
| Gerson Paull | Pathology | Southeastern Pathology Associates PC | 801 W Gordon St, Thomaston, GA 30286-3426 |
| Curtis Clayton Howell Ii | Certified Registered Nurse Anesthetist (crna) | Guardian Medical Services LLC | 801 W Gordon St, Thomaston, GA 30286-3426 |
| Ian B Campbell | Diagnostic Radiology | South Georgia Radiology Associates LLC | 801 W Gordon St, Thomaston, GA 30286-3426 |
| Bert Puckett Wall | Family Medicine | Hightower Physician Services, PC | 801 W Gordon St, Thomaston, GA 30286-3426 |
| Anthony J Marchetti | Internal Medicine | Hightower Emergency Group PC | 801 W Gordon St, Thomaston, GA 30286-3426 |
| Jonathan Brinser | Certified Registered Nurse Anesthetist (crna) | Guardian Medical Services LLC | 801 W Gordon St, Thomaston, GA 30286-3426 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mary S Gamel | Nurse Practitioner | Upson Family Medical Center, LLC | 1512 Hwy 19 N, Thomaston, GA 30286-2258 |
| George L Capo | Family Medicine | Upson Family Medical Center, LLC | 1512 Hwy 19 N, Thomaston, GA 30286-2258 |
| Lisa Hammock | Nurse Practitioner | Upson Family Medical Center, LLC | 1512 Hwy 19 N, Thomaston, GA 30286-2258 |
| Jessica E Strickland | Nurse Practitioner | Upson Family Medical Center, LLC | 1512 Hwy 19 N, Thomaston, GA 30286-2258 |
| Jonniece Priester | Nurse Practitioner | Upson Family Medical Center, LLC | 1512 Hwy 19 N, Thomaston, GA 30286-2258 |
| Hugh D Smith Ii | Obstetrics/gynecology | Upson Womens Services LLC | 214 Cherokee Rd, Thomaston, GA 30286-3402 |
| Lethenia Joy Baker | Obstetrics/gynecology | Upson Womens Services LLC | 214 Cherokee Rd, Thomaston, GA 30286-3402 |
| Rhonda M Brooks | Nurse Practitioner | Upson Womens Services LLC | 214 Cherokee Rd, Thomaston, GA 30286-3402 |
| Nicolas Psomiadis | Obstetrics/gynecology | Upson Womens Services LLC | 214 Cherokee Rd, Thomaston, GA 30286-3402 |
| Darryl H Knight | General Surgery | Upson Surgical Associates, LLC | 612 W Gordon St, Suite E, Thomaston, GA 30286-3416 |
| Find all physicians in zip 30286 | |||
| City | THOMASTON |
| Zip Code | 30286 |
| Specialty | PATHOLOGY |
| City + Specialty | THOMASTON + PATHOLOGY |
Please comment or provide details below to improve the information on Carolyn Kinzer Bezanson Wall.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.