Healthcare Provider Details

I. General information

NPI: 1154209666
Provider Name (Legal Business Name): MEDPRO POINT OF CARE MOBILE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6941 HIGHWAY 92 STE 120A
WOODSTOCK GA
30189-3465
US

IV. Provider business mailing address

6941 GA-92 SUITE 120A
ACWORTH GA
30189
US

V. Phone/Fax

Practice location:
  • Phone: 770-402-8116
  • Fax: 404-566-7923
Mailing address:
  • Phone: 770-402-8116
  • Fax: 404-855-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. LATOYA BLAKE
Title or Position: CEO/OWNER
Credential: PA-S, CCMA, CPHT
Phone: 770-402-8116