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General NPI Number Information
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NPI Number | 1205613700
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Entity Type | Organization
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Legal Business Name | MEYTY MOBILE LABS
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 5 FITZWATER RD
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City | PORT WENTWORTH
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State | GA
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Zip | 31407-6016
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Country | US
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Telephone | 912-272-7739
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Fax |
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Provider Business Mailing Address
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Address Line | 5 FITZWATER RD
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City | PORT WENTWORTH
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State | GA
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Zip | 31407-6016
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Country | US
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Telephone | 912-272-7739
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. YVETTA EVANS-WHITE
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Credential |
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Telephone | 912-272-7739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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