Healthcare Provider Details

I. General information

NPI: 1043433634
Provider Name (Legal Business Name): PRESBYTERIAN REGIONAL HEALTHCARE LABORATORY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 E 3RD ST
CHARLOTTE NC
28204-3205
US

IV. Provider business mailing address

PO BOX 468029
ATLANTA GA
31146-8029
US

V. Phone/Fax

Practice location:
  • Phone: 404-943-0205
  • Fax:
Mailing address:
  • Phone: 404-943-0205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ALICIA HOLDEN
Title or Position: LEAD
Credential: ACCOUNTING
Phone: 404-943-0205