Healthcare Provider Details

I. General information

NPI: 1629964721
Provider Name (Legal Business Name): PONYA DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 CORPORATE BLVD NE STE 100
BROOKHAVEN GA
30329-1905
US

IV. Provider business mailing address

13 CORPORATE BLVD NE STE 250
BROOKHAVEN GA
30329-1901
US

V. Phone/Fax

Practice location:
  • Phone: 229-442-7210
  • Fax: 404-759-2019
Mailing address:
  • Phone: 229-442-7210
  • Fax: 404-759-2019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. MEKONNEN ABEBE
Title or Position: OWNER
Credential:
Phone: 229-442-7210