Healthcare Provider Details

I. General information

NPI: 1740482678
Provider Name (Legal Business Name): JOHNSONS' DRAWING AND PROCESSING LAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S COURT ST
OPELOUSAS LA
70570-5125
US

IV. Provider business mailing address

PO BOX 671
OPELOUSAS LA
70571-0671
US

V. Phone/Fax

Practice location:
  • Phone: 337-948-4481
  • Fax: 337-948-4437
Mailing address:
  • Phone: 337-948-4481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLP.200901-PHL
License Number StateLA

VIII. Authorized Official

Name: HENDERSON JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 33794844841