Healthcare Provider Details

I. General information

NPI: 1730932690
Provider Name (Legal Business Name): GIFTED HANDS PREMIUM MOBILE LAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HAMMOCK LN
RAEFORD NC
28376-2738
US

IV. Provider business mailing address

300 HAMMOCK LN
RAEFORD NC
28376-2738
US

V. Phone/Fax

Practice location:
  • Phone: 910-613-0787
  • Fax: 910-613-0379
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DETORIA WHITNEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 910-613-0378