Healthcare Provider Details

I. General information

NPI: 1316370950
Provider Name (Legal Business Name): ACADIAN DIAGNOSTIC LABORATORIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11842 JUSTICE AVE
BATON ROUGE LA
70816-5324
US

IV. Provider business mailing address

11842 JUSTICE AVE
BATON ROUGE LA
70816-5324
US

V. Phone/Fax

Practice location:
  • Phone: 225-448-5886
  • Fax:
Mailing address:
  • Phone: 225-448-5886
  • Fax:

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: MR. TERRY S WILKS JR.
Title or Position: CEO/OWNER
Credential:
Phone: 225-448-5886