MEDICARE: HOLY SPIRIT PHLEBOTOMY LAB LLC

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	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1598644379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLY SPIRIT PHLEBOTOMY LAB LLC

Provider Business Mailing Address
First Line	:	8735 DUNWOODY PL STE 10564
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-2995
Country	:	US
Telephone Number	:	706-418-7607
Fax Number	:

Provider Business Practice Location Address
First Line	:	8735 DUNWOODY PL STE N
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-2995
Country	:	US
Telephone Number	:	706-418-7607
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HOLY SPIRIT PHLEBO LABORATORIES
Credential	:	PBT
Telephone Number	:	706-418-7607

Provider Enumeration Date	:	08/27/2025
Last Update Date	:	09/05/2025

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