Healthcare Provider Details

I. General information

NPI: 1609692128
Provider Name (Legal Business Name): FIELD LABS DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2024
Last Update Date: 11/30/2024
Certification Date: 11/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 COMMERCE BLVD
RIVERDALE GA
30296-7198
US

IV. Provider business mailing address

35 SUMMER LEIGH DR
STOCKBRIDGE GA
30281-5895
US

V. Phone/Fax

Practice location:
  • Phone: 404-452-2817
  • Fax:
Mailing address:
  • Phone: 404-452-2817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: APRIL R PAULK
Title or Position: OWNER
Credential: CPT, CNA
Phone: 404-452-2817