Healthcare Provider Details

I. General information

NPI: 1083290431
Provider Name (Legal Business Name): LEGACY LAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 MCLAWS CIR STE 103
WILLIAMSBURG VA
23185-5861
US

IV. Provider business mailing address

241 MCLAWS CIR STE 103
WILLIAMSBURG VA
23185-5861
US

V. Phone/Fax

Practice location:
  • Phone: 757-880-9280
  • Fax:
Mailing address:
  • Phone: 757-880-9280
  • 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: ARLEIGH HATCHER
Title or Position: OWNER
Credential: RN
Phone: 757-880-9280