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General NPI Number Information
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NPI Number | 1164242079
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Entity Type | Organization
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Legal Business Name | AJS MOBILE LAB SERVICES LLC
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 1021 EDEN WAY N STE 118
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2776
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Country | US
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Telephone | 855-956-2822
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 EDEN WAY N STE 118
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2776
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Country | US
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Telephone | 855-956-2822
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ANTHONY KELLAM
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Credential |
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Telephone | 855-956-2822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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