Healthcare Provider Details

I. General information

NPI: 1285569293
Provider Name (Legal Business Name): BJK SPECIMEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 CARROLLTON VILLA RICA HWY STE 110
VILLA RICA GA
30180-5193
US

IV. Provider business mailing address

1836 CARROLLTON VILLA RICA HWY STE 110
VILLA RICA GA
30180-5193
US

V. Phone/Fax

Practice location:
  • Phone: 404-410-6800
  • Fax: 404-410-6800
Mailing address:
  • Phone: 404-410-6800
  • Fax: 404-410-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KENDRA FORBES-LINDLEY
Title or Position: OWNER
Credential:
Phone: 404-410-6800