Healthcare Provider Details

I. General information

NPI: 1003742115
Provider Name (Legal Business Name): JC FAMILY TESTING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11555 MEDLOCK BRIDGE RD
JOHNS CREEK GA
30097-1564
US

IV. Provider business mailing address

11555 MEDLOCK BRIDGE RD STE 100
JOHNS CREEK GA
30097-3200
US

V. Phone/Fax

Practice location:
  • Phone: 678-360-0873
  • Fax:
Mailing address:
  • Phone:
  • 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: HARICHARAN TEJA MADDURI
Title or Position: PRESEIDENT
Credential:
Phone: 678-360-0873