Healthcare Provider Details

I. General information

NPI: 1366029282
Provider Name (Legal Business Name): IK MEDICAL DIAGNOSTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 OLD RADIUM SPRINGS RD
ALBANY GA
31705-3599
US

IV. Provider business mailing address

213 OLD RADIUM SPRINGS RD
ALBANY GA
31705-3599
US

V. Phone/Fax

Practice location:
  • Phone: 833-592-1716
  • Fax:
Mailing address:
  • Phone: 833-592-1716
  • Fax: 236-233-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: FEMI BARRETT
Title or Position: OWNER
Credential:
Phone: 229-603-2465