Healthcare Provider Details

I. General information

NPI: 1336003821
Provider Name (Legal Business Name): HAZELS TOUCH LABORATORY SERVICES L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W EDEN ST
EDENTON NC
27932-1844
US

IV. Provider business mailing address

3115 DAVENPORT FORK RD
CRESWELL NC
27928-9387
US

V. Phone/Fax

Practice location:
  • Phone: 252-484-5413
  • Fax:
Mailing address:
  • Phone:
  • 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: DIAMOND DILLARD
Title or Position: OWNER
Credential:
Phone: 252-484-5413