NPI 1124002712

Carolyn Kinzer-Bezanson Wall, MD

Practitioner Anatomic Pathology & Clinical Pathology Physician Brunswick, GA

Practice location

Address: 203 Indigo Drive Southeastern Pathology Associates, PC, Brunswick, GA 31525
Phone: (912) 279-1900
Fax: (912) 261-0753
Mailing address: PO Box 30309, Charleston, SC 29417

Registered specialties (5)

Anatomic Pathology & Clinical Pathology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207ZP0102X Licence 038275 (GA)

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Anatomic Pathology & Clinical Pathology Physician

Allopathic & Osteopathic Physicians Taxonomy 207ZP0102X Licence MD29387 (SC)

Anatomic Pathology & Clinical Pathology Physician

Allopathic & Osteopathic Physicians Taxonomy 207ZP0102X Licence MD317652 (AL)

Anatomic Pathology & Clinical Pathology Physician

Allopathic & Osteopathic Physicians Taxonomy 207ZP0102X Licence MD.12093R/INACTIVE (LA)

Registry record

NPI: 1124002712
Entity type: Individual
Sex (as registered): Female
NPI issued: 6 Dec 2005
Record last updated: 5 Dec 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.