1. Home
  2. Directory
  3. Georgia
  4. Brunswick
  5. Pathology
  6. NPI Profile
  7. NPI Record 1124002712

CAROLYN KINZER-BEZANSON WALL M.D.
Complete NPI Record 1124002712
Pathology - Anatomic Pathology & Clinical Pathology in Brunswick, GA


Quality Rating: 78.63 out of 100 score

NPI Status: Active since December 06, 2005

Contact Information

203 INDIGO DRIVE
SOUTHEASTERN PATHOLOGY ASSOCIATES, PC
BRUNSWICK, GA
ZIP 31525
Phone: (912) 279-1900
Fax: (912) 261-0753

Get Directions

Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Credential Text
  7. Provider Other Last Name
  8. Provider Other First Name
  9. Provider Other Middle Name
  10. Provider Other Credential Text
  11. Provider Other Last Name Type Code
  12. Provider First Line Business Mailing Address
  13. Provider Business Mailing Address City Name
  14. Provider Business Mailing Address State Name
  15. Provider Business Mailing Address Postal Code
  16. Provider Business Mailing Address Country Code If outside U S
  17. Provider Business Mailing Address Telephone Number
  18. Provider Business Mailing Address Fax Number
  19. Provider First Line Business Practice Location Address
  20. Provider Second Line Business Practice Location Address
  21. Provider Business Practice Location Address City Name
  22. Provider Business Practice Location Address State Name
  23. Provider Business Practice Location Address Postal Code
  24. Provider Business Practice Location Address Country Code If outside U S
  25. Provider Business Practice Location Address Telephone Number
  26. Provider Business Practice Location Address Fax Number
  27. Provider Enumeration Date
  28. Last Update Date
  29. Provider Gender Code
  30. Healthcare Provider Taxonomy Code 1
  31. Provider License Number 1
  32. Provider License Number State Code 1
  33. Healthcare Provider Primary Taxonomy Switch 1
  34. Healthcare Provider Taxonomy Code 2
  35. Provider License Number 2
  36. Provider License Number State Code 2
  37. Healthcare Provider Primary Taxonomy Switch 2
  38. Healthcare Provider Taxonomy Code 3
  39. Provider License Number 3
  40. Provider License Number State Code 3
  41. Healthcare Provider Primary Taxonomy Switch 3
  42. Healthcare Provider Taxonomy Code 4
  43. Provider License Number 4
  44. Provider License Number State Code 4
  45. Healthcare Provider Primary Taxonomy Switch 4
  46. Healthcare Provider Taxonomy Code 5
  47. Provider License Number 5
  48. Provider License Number State Code 5
  49. Healthcare Provider Primary Taxonomy Switch 5
  50. Other Provider Identifier 1
  51. Other Provider Identifier Type Code 1
  52. Other Provider Identifier State 1
  53. Other Provider Identifier 2
  54. Other Provider Identifier Type Code 2
  55. Other Provider Identifier State 2
  56. Other Provider Identifier 3
  57. Other Provider Identifier Type Code 3
  58. Other Provider Identifier State 3
  59. Other Provider Identifier 4
  60. Other Provider Identifier Type Code 4
  61. Other Provider Identifier State 4
  62. Other Provider Identifier 5
  63. Other Provider Identifier Type Code 5
  64. Other Provider Identifier State 5
  65. Other Provider Identifier 6
  66. Other Provider Identifier Type Code 6
  67. Other Provider Identifier State 6
  68. Other Provider Identifier 7
  69. Other Provider Identifier Type Code 7
  70. Other Provider Identifier State 7
  71. Other Provider Identifier 8
  72. Other Provider Identifier Type Code 8
  73. Other Provider Identifier State 8
  74. Is Sole Proprietor

Complete NPI Dataset

This page represents the complete record for NPI 1124002712. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1124002712
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: CAROLYN
The date the provider was assigned a unique identifier (assigned an NPI).
Provider Middle Name: KINZER-BEZANSON
The date that a record was last updated or changed.
Provider Credential Text: M.D.
The code designating the provider’s gender if the provider is a person.
Provider Other Last Name: KINZER-BEZANSON
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider Other First Name: CAROLYN
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider Other Middle Name: A
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Provider Other Credential Text: M.D.
Provider Other Last Name Type Code: 5
Provider First Line Business Mailing Address: PO BOX 30309
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider Business Mailing Address City Name: CHARLESTON
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Provider Business Mailing Address State Name: SC
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Provider Business Mailing Address Postal Code: 29417
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 8435549300
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 8435668780
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider First Line Business Practice Location Address: 203 INDIGO DRIVE
The city name in the location address of the provider being identified.
Provider Second Line Business Practice Location Address: SOUTHEASTERN PATHOLOGY ASSOCIATES, PC
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: BRUNSWICK
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: GA
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 31525
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 9122791900
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 9122610753
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider Enumeration Date: 12/6/2005
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Last Update Date: 12/5/2014
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Provider Gender Code: F
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 207ZP0102X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 038275
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: GA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Healthcare Provider Taxonomy Code 2: 207ZP0102X
Provider License Number 2: MD.12093R/INACTIVE
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: LA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 207ZP0102X
Provider License Number 3: MD317652
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3: AL
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 207ZP0102X
Provider License Number 4: MD29387
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 4: SC
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 4: N
Healthcare Provider Taxonomy Code 5: 207ZP0102X
Provider License Number 5: ME85489
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 5: FL
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 5: N
Other Provider Identifier 1: 000931356C
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: GA
Other Provider Identifier 2: 000931356
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: GA
Other Provider Identifier 3: 000931356A
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: GA
Other Provider Identifier 4: 000931356B
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: GA
Other Provider Identifier 5: 000931356D
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5: GA
Other Provider Identifier 6: 000931356I
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 6: GA
Other Provider Identifier 7: 000931356F
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 7: GA
Other Provider Identifier 8: 000931356E
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 8: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 8: GA
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No