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General NPI Number Information
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NPI Number | 1235021767
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Entity Type | Organization
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Legal Business Name | JLA3 SERVICES LLC
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 6077 N HENRY BLVD
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-3041
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Country | US
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Telephone | 404-441-3627
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Fax |
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Provider Business Mailing Address
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Address Line | 6077 N HENRY BLVD
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-3041
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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 | OWNER
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Name | SAMERICA JACKSON-CLARK
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Credential |
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Telephone | 404-441-3627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #3
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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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