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General NPI Number Information
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NPI Number | 1164210266
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Entity Type | Organization
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Legal Business Name | CONCIERGE DIAGNOSTIC SERVICES LLC
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 1220 2ND AVE STE 6
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City | COLUMBUS
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State | GA
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Zip | 31901-1114
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Country | US
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Telephone | 470-241-6604
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Fax | 706-940-4415
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Provider Business Mailing Address
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Address Line | 1220 2ND AVE STE 106
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City | COLUMBUS
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State | GA
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Zip | 31901-1111
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Country | US
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Telephone | 470-241-6604
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Fax | 706-940-4415
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. CORINTHIANS DEQUINDRAE WASHINGTON, ED.D.
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Credential | DO, CDCA, ED.D.
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Telephone | 470-241-6604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0104X
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Taxonomy Name | Chemical Pathology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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