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General NPI Number Information
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NPI Number | 1114715869
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Entity Type | Organization
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Legal Business Name | VITATRACE TESTING, LLC
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 1840 PYRAMID PL # 244
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City | MEMPHIS
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State | TN
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Zip | 38132-1703
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Country | US
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Telephone | 901-649-5191
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Fax |
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Provider Business Mailing Address
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Address Line | 1840 PYRAMID PL # 244
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City | MEMPHIS
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State | TN
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Zip | 38132-1703
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Country | US
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Telephone | 901-649-5191
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANTONISHA ADAIR
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Credential | MSW
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Telephone | 901-315-7652
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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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