Healthcare Provider Details

I. General information

NPI: 1760136105
Provider Name (Legal Business Name): MEDICAL TESTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 03/28/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 MAGNAVIEW DR
MCDONOUGH GA
30253-3039
US

IV. Provider business mailing address

137 MAGNAVIEW DR
MCDONOUGH GA
30253-3039
US

V. Phone/Fax

Practice location:
  • Phone: 321-216-7352
  • Fax: 404-393-0703
Mailing address:
  • Phone: 321-216-7352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: BASHAH T GAINES
Title or Position: OWNER/OPERATOR
Credential:
Phone: 321-216-7352