Healthcare Provider Details

I. General information

NPI: 1992661565
Provider Name (Legal Business Name): INNOVEX DIAGNOSTIC SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3176 MAIN ST
DULUTH GA
30096-3262
US

IV. Provider business mailing address

3176 MAIN ST
DULUTH GA
30096-3262
US

V. Phone/Fax

Practice location:
  • Phone: 470-632-1010
  • Fax:
Mailing address:
  • Phone: 470-632-1010
  • Fax:

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: GARY CLOWERS SR.
Title or Position: MANAGER
Credential:
Phone: 470-632-1010