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General NPI Number Information
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NPI Number | 1194431718
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Entity Type | Organization
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Legal Business Name | FOUR CORNERS TESTING LLC
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Dates
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Enumeration Date | 01/26/2023
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 4050 GA-42
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City | LOCUST GROVE
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State | GA
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Zip | 30248
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Country | US
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Telephone | 206-371-3336
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Fax |
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Provider Business Mailing Address
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Address Line | 14150 NE 20TH ST # F1-282
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City | BELLEVUE
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State | WA
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Zip | 98007-3700
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | BRYAN JONES
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Credential |
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Telephone | 206-371-3336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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