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General NPI Number Information
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NPI Number | 1154209666
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Entity Type | Organization
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Legal Business Name | MEDPRO POINT OF CARE MOBILE SERVICES, LLC
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Dates
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Enumeration Date | 08/22/2025
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Last Update Date | 12/13/2025
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Provider Practice Location Address
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Address Line | 5701 MABLETON PKWY SW STE 112
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City | MABLETON
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State | GA
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Zip | 30126-3395
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Country | US
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Telephone | 770-402-8116
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Fax | 404-566-7923
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Provider Business Mailing Address
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Address Line | 5701 MABLETON PKWY SW STE 112
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City | MABLETON
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State | GA
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Zip | 30126-3395
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Country | US
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Telephone | 770-402-8116
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Fax | 404-566-7923
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MS. LATOYA BLAKE
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Credential | PA-S, CCMA, CPHT
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Telephone | 770-402-8116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number |
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License Number State |
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