Healthcare Provider Details

I. General information

NPI: 1861136947
Provider Name (Legal Business Name): PRECISION CLINICAL DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 E PONCE DE LEON AVE STE B
CLARKSTON GA
30021-1839
US

IV. Provider business mailing address

4600 E PONCE DE LEON AVE STE B
CLARKSTON GA
30021-1839
US

V. Phone/Fax

Practice location:
  • Phone: 470-418-4458
  • Fax:
Mailing address:
  • Phone: 470-418-4458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAWIT MENGESHA
Title or Position: PRESIDENT
Credential:
Phone: 470-418-4458