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General NPI Number Information
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NPI Number | 1205653672
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Entity Type | Organization
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Legal Business Name | DEFINE BLISS AND LAB INC
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Dates
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Enumeration Date | 09/25/2024
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 1000 CORPORATE POINTE STE 309
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City | WARNER ROBINS
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State | GA
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Zip | 31088-3441
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Country | US
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Telephone | 478-777-6141
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Fax |
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Provider Business Mailing Address
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Address Line | 103 KARIS CT
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City | PERRY
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State | GA
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Zip | 31069-4878
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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 | DIRECTOR
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Name | JAKELL THOMAS
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Credential | MA
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Telephone | 478-777-6141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State |
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