=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184041949
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARADIGM LABS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2014
-----------------------------------------------------
Last Update Date | 01/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1302 FOUNTAIN PARK CIRCLE
-----------------------------------------------------
City | BRUNSWICK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31520-4860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-342-2443
-----------------------------------------------------
Fax | 912-634-5246
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1302 FOUNTAIN PARK CIRCLE
-----------------------------------------------------
City | BRUNSWICK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31520-4860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-342-2443
-----------------------------------------------------
Fax | 912-634-5246
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | CATHERINE WOLFE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 912-342-2443
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------