Healthcare Provider Details

I. General information

NPI: 1316832629
Provider Name (Legal Business Name): SPECIMEN COMPLIANCE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 MILLRUN CT
MACON GA
31210
US

IV. Provider business mailing address

1302 WATSON BLVD
WARNER ROBINS GA
31093-3436
US

V. Phone/Fax

Practice location:
  • Phone: 803-236-5333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JONIECE DORSEY
Title or Position: OWNER
Credential:
Phone: 803-236-5333