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General NPI Number Information
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NPI Number | 1225413099
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Entity Type | Organization
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Legal Business Name | SOUTH GEORGIA TOXICOLOGY, INC
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Dates
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Enumeration Date | 07/22/2015
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Last Update Date | 07/06/2017
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Provider Practice Location Address
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Address Line | 3312 N OAK STREET EXT B3
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City | VALDOSTA
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State | GA
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Zip | 31605-1065
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Country | US
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Telephone | 229-242-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 3312 N OAK STREET EXT B3
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City | VALDOSTA
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State | GA
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Zip | 31605-1065
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Country | US
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Telephone | 229-242-4600
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ED DRAMBEL
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Credential |
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Telephone | 229-242-4600
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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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