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General NPI Number Information
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NPI Number | 1093069270
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Entity Type | Organization
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Legal Business Name | CONFIRMATRIX LABORATORY INC
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Dates
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Enumeration Date | 11/09/2012
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 1770 CEDARS RD STE 200
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-6702
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Country | US
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Telephone | 678-407-9818
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Fax | 678-407-9819
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Provider Business Mailing Address
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Address Line | 1770 CEDARS RD STE 200
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-6702
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Country | US
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Telephone | 678-407-9818
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Fax | 678-407-9819
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Authorized Official
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Title or Position | CEO
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Name | MS. ANN DURHAM
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Credential |
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Telephone | 678-407-9818
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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 | 12030R
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License Number State | GA
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