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General NPI Number Information
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NPI Number | 1104274075
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Entity Type | Organization
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Legal Business Name | AFFINITY HEALTH GROUP, LLC
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Dates
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Enumeration Date | 06/01/2016
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Last Update Date | 06/01/2016
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Provider Practice Location Address
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Address Line | 2516 BROADMOOR BOULEVARD SUITE 1C
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City | MONROE
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State | LA
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Zip | 71201
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Country | US
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Telephone | 318-807-4710
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Fax | 318-361-2195
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Provider Business Mailing Address
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Address Line | 130 DESIARD ST SUITE 355
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City | MONROE
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State | LA
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Zip | 71201-7319
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Country | US
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Telephone | 318-807-7875
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Fax | 318-812-6603
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MS. JANET JUSTICE
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Credential |
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Telephone | 318-807-7875
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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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