Healthcare Provider Details

I. General information

NPI: 1972277572
Provider Name (Legal Business Name): LOGICAL MOBILE LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7319 BEACON HILL LN APT 26
CHARLOTTE NC
28270-5994
US

IV. Provider business mailing address

7319 BEACON HILL LN APT 26
CHARLOTTE NC
28270-5994
US

V. Phone/Fax

Practice location:
  • Phone: 704-773-7475
  • Fax:
Mailing address:
  • Phone: 704-773-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246R00000X
TaxonomyPathology Technician
License Number
License Number State

VIII. Authorized Official

Name: SABRINA HICKENBOTHAM
Title or Position: MEDICAL LABORATORY TECHNICIAN
Credential:
Phone: 704-773-7475