Healthcare Provider Details

I. General information

NPI: 1134082969
Provider Name (Legal Business Name): CENTRAL GEORGIA DRUG & DNA TESTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 ANNA CLAIRE WAY
PERRY GA
31069-9482
US

IV. Provider business mailing address

110 ANNA CLAIRE WAY
PERRY GA
31069-9482
US

V. Phone/Fax

Practice location:
  • Phone: 478-758-1125
  • Fax:
Mailing address:
  • Phone: 478-758-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PRINCESS JACKSON
Title or Position: FOUNDER
Credential:
Phone: 478-758-1125