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General NPI Number Information
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NPI Number | 1083382592
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Entity Type | Organization
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Legal Business Name | PRECISION LIFE SCIENCES LLC
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 05/19/2022
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Provider Practice Location Address
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Address Line | 4850 GOODMAN RD STE 101
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-7906
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Country | US
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Telephone | 615-556-6628
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Fax |
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Provider Business Mailing Address
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Address Line | 4850 GOODMAN RD STE 101
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-7906
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Country | US
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Telephone | 615-556-6628
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ANDREW WISEMAN
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Credential |
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Telephone | 615-556-6628
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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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