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General NPI Number Information
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NPI Number | 1023877065
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Entity Type | Organization
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Legal Business Name | K-LAB AND MORE
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Dates
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Enumeration Date | 03/13/2024
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Last Update Date | 03/16/2024
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Provider Practice Location Address
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Address Line | 138 SOUTH MAIN ST SUITE A
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City | REIDSVILLE
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State | GA
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Zip | 30453
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Country | US
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Telephone | 912-322-4161
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Fax |
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Provider Business Mailing Address
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Address Line | 120 OAK STREET
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City | REIDSVILLE
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State | GA
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Zip | 30453
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Country | US
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Telephone | 912-322-4161
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Fax |
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Authorized Official
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Title or Position | CEO/ OWNER
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Name | BRIANNA MIKKEA BEAL
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Credential | CCMA
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Telephone | 912-322-4161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State |
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