Healthcare Provider Details

I. General information

NPI: 1134885155
Provider Name (Legal Business Name): IN & OUT LAB SCREENINGS LTD LIABILTY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2021
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 LEDO RD STE B
ALBANY GA
31707-1813
US

IV. Provider business mailing address

1900 LEDO RD STE B
ALBANY GA
31707-1813
US

V. Phone/Fax

Practice location:
  • Phone: 229-903-5272
  • Fax: 229-808-1970
Mailing address:
  • Phone: 222-903-5272
  • Fax: 229-808-1970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: MONIERICA THOMAS
Title or Position: LAB DIRECTOR
Credential:
Phone: 229-903-5272