Healthcare Provider Details

I. General information

NPI: 1164962882
Provider Name (Legal Business Name): IPSUM DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8607 ROBERTS DR STE 250
ATLANTA GA
30350-2237
US

IV. Provider business mailing address

8607 ROBERTS DR STE 250
ATLANTA GA
30350-2237
US

V. Phone/Fax

Practice location:
  • Phone: 678-915-2299
  • Fax: 833-964-0184
Mailing address:
  • Phone: 678-915-2299
  • Fax: 833-964-0184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number11D2125186
License Number StateGA

VIII. Authorized Official

Name: COLIN ROGERS
Title or Position: MANAGER
Credential:
Phone: 404-441-8180