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General NPI Number Information
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NPI Number | 1184439945
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Entity Type | Organization
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Legal Business Name | TOTAL LAB DIAGNOSTICS LLC
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 439 NORTH ST STE D
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-2937
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Country | US
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Telephone | 888-472-7049
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Fax |
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Provider Business Mailing Address
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Address Line | 439 NORTH ST STE D
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-2937
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Country | US
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Telephone | 888-472-7049
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GIGLA DVALISHVILI
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Credential |
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Telephone | 888-472-7049
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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 |
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License Number State |
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