=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255787420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN PROFESSIONAL ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2016
-----------------------------------------------------
Last Update Date | 05/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 270 CARPENTER DR SUITE 600
-----------------------------------------------------
City | SANDY SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30328-4931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-400-6686
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2870 PEACHTREE RD NW # 885
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30305-2918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-400-6686
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LAB DIRECTOR
-----------------------------------------------------
Name | JAN C KENNEDY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 404-400-6686
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 96004
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------