Healthcare Provider Details

I. General information

NPI: 1437802188
Provider Name (Legal Business Name): PURPOSEFUL HEALTH & LAB SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 MOUNT ZION RD STE 10
MORROW GA
30260-2241
US

IV. Provider business mailing address

1115 MOUNT ZION RD STE 10
MORROW GA
30260-2241
US

V. Phone/Fax

Practice location:
  • Phone: 770-917-2570
  • Fax:
Mailing address:
  • Phone: 770-917-2570
  • 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

VIII. Authorized Official

Name: ADRIENE ZACKERY
Title or Position: CEO/OWNER
Credential: NURSE
Phone: 770-703-6979