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General NPI Number Information
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NPI Number | 1255851143
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Entity Type | Organization
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Legal Business Name | HORIZON DIAGNOSTIC LABORATORY
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 508 N MAIN ST STE B1
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City | HINESVILLE
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State | GA
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Zip | 31313-2570
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Country | US
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Telephone | 912-785-2101
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Fax | 912-785-2114
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Provider Business Mailing Address
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Address Line | 508 N MAIN ST STE B1
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City | HINESVILLE
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State | GA
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Zip | 31313-2570
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Country | US
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Telephone | 912-785-2101
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Fax | 912-785-2114
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Authorized Official
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Title or Position | OWNER
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Name | AFOLARIN BANJOKO
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Credential | MD
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Telephone | 912-785-2101
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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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