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General NPI Number Information
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NPI Number | 1063840429
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Entity Type | Organization
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Legal Business Name | PHYSICIAN LABORATORY CONSULTANTS LLC
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Dates
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Enumeration Date | 10/23/2013
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Last Update Date | 07/11/2016
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Provider Practice Location Address
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Address Line | 130 N BROAD ST
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City | THOMASVILLE
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State | GA
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Zip | 31792-8132
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Country | US
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Telephone | 800-899-5757
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 78545
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City | SAINT LOUIS
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State | MO
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Zip | 63178-8545
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Country | US
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Telephone | 800-899-5757
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | JANET TANNER
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Credential |
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Telephone | 229-228-6496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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