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General NPI Number Information
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NPI Number | 1255339107
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Entity Type | Organization
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Legal Business Name | LIFETEST OF GEORGIA, LLC
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1140 HAMMOND DR NE BUILDING I, STE 9120
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City | ATLANTA
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State | GA
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Zip | 30328-5338
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Country | US
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Telephone | 770-730-0119
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Fax | 770-730-0114
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Provider Business Mailing Address
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Address Line | 1140 HAMMOND DR NE BUILDING I, STE 9120
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City | ATLANTA
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State | GA
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Zip | 30328-5338
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Country | US
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Telephone | 770-730-0119
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Fax | 770-730-0114
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LEE GALLAGHER
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Credential |
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Telephone | 770-730-0119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | BL02-11466
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number | BL02-11466
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License Number State | GA
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