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General NPI Number Information
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NPI Number | 1134079973
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Entity Type | Organization
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Legal Business Name | BURGEON MEDIX LLC
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Dates
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Enumeration Date | 01/31/2026
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 2336 WISTERIA DR STE 510
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City | SNELLVILLE
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State | GA
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Zip | 30078-6159
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Country | US
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Telephone | 470-469-1945
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Fax |
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Provider Business Mailing Address
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Address Line | 2336 WISTERIA DR STE 510
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City | SNELLVILLE
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State | GA
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Zip | 30078-6159
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Country | US
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Telephone | 470-469-1945
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Fax |
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Authorized Official
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Title or Position | LAB DIRECTOR
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Name | QUEEN-ESTHER ADAOBI RAPHAEL
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Credential | BSC,CPT-NHA
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Telephone | 470-469-1945
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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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