MEDICARE: DNA TESTING ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1215899885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DNA TESTING ASSOCIATES

Provider Business Mailing Address
First Line	:	117 ALPINE CIR STE 600-D
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-6523
Country	:	US
Telephone Number	:	803-400-8752
Fax Number	:	803-403-0361

Provider Business Practice Location Address
First Line	:	117 ALPINE CIR STE 600-D
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-6523
Country	:	US
Telephone Number	:	803-400-8752
Fax Number	:	803-403-0361

Authorized Official
Title or Position	:	CEO
Name	:	WILLIE DEMETRIUS BURRELL
Credential	:
Telephone Number	:	803-400-8752

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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