Healthcare Provider Details

I. General information

NPI: 1902552946
Provider Name (Legal Business Name): A1 DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3225 CREEK TRCE W
POWDER SPRINGS GA
30127-9055
US

IV. Provider business mailing address

9842 BOSQUE CREEK CIR APT 202
TAMPA FL
33619-5154
US

V. Phone/Fax

Practice location:
  • Phone: 678-499-5745
  • Fax:
Mailing address:
  • Phone: 678-499-5745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: CYNETRA ZOLLICOFFER
Title or Position: OWNER
Credential:
Phone: 678-499-5745