Healthcare Provider Details

I. General information

NPI: 1033544630
Provider Name (Legal Business Name): ATLANTIC DIAGNOSTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 W SOUTH STREET SUITE 202
HERNANDO MS
38632-2266
US

IV. Provider business mailing address

1785 NONCONNAH BOULEVARD SUITE 107
MEMPHIS TN
38132-2140
US

V. Phone/Fax

Practice location:
  • Phone: 855-717-6838
  • Fax: 888-371-4191
Mailing address:
  • Phone: 662-449-8200
  • Fax: 888-891-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN PEREIRA
Title or Position: MANAGING MEMBER
Credential:
Phone: 662-469-3000