Healthcare Provider Details

I. General information

NPI: 1902645260
Provider Name (Legal Business Name): PRETTYSTICKS MOBILE PHLEBOTOMY CONCIERGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8735 DUNWOODY PL # 5992
ATLANTA GA
30350-2995
US

IV. Provider business mailing address

501 HARVICK CIR
STOCKBRIDGE GA
30281-4457
US

V. Phone/Fax

Practice location:
  • Phone: 757-679-7134
  • Fax: 770-809-5077
Mailing address:
  • Phone: 757-679-7134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: KETRA PARSON
Title or Position: CEO/PROGRAM DIRECTOR
Credential: NCPT, CPI
Phone: 757-679-7134