Healthcare Provider Details

I. General information

NPI: 1164210266
Provider Name (Legal Business Name): CONCIERGE DIAGNOSTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 2ND AVE STE 6
COLUMBUS GA
31901-1114
US

IV. Provider business mailing address

1220 2ND AVE STE 106
COLUMBUS GA
31901-1111
US

V. Phone/Fax

Practice location:
  • Phone: 470-241-6604
  • Fax: 706-940-4415
Mailing address:
  • Phone: 470-241-6604
  • Fax: 706-940-4415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0104X
TaxonomyChemical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: DR. CORINTHIANS DEQUINDRAE WASHINGTON, ED.D.
Title or Position: ADMINISTRATOR
Credential: DO, CDCA, ED.D.
Phone: 470-241-6604