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General NPI Number Information
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NPI Number | 1164962882
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Entity Type | Organization
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Legal Business Name | IPSUM DIAGNOSTICS LLC
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 8607 ROBERTS DR STE 250
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City | ATLANTA
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State | GA
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Zip | 30350-2237
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Country | US
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Telephone | 678-915-2299
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Fax | 833-964-0184
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Provider Business Mailing Address
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Address Line | 8607 ROBERTS DR STE 250
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City | ATLANTA
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State | GA
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Zip | 30350-2237
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Country | US
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Telephone | 678-915-2299
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Fax | 833-964-0184
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Authorized Official
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Title or Position | MANAGER
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Name | COLIN ROGERS
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Credential |
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Telephone | 404-441-8180
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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 | 11D2125186
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License Number State | GA
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