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General NPI Number Information
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NPI Number | 1306501556
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Entity Type | Organization
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Legal Business Name | YOUR CHOICE LABORATORY
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Dates
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Enumeration Date | 11/02/2021
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 3818 NORTHLAKE CREEK DR
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City | TUCKER
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State | GA
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Zip | 30084-3418
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Country | US
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Telephone | 404-988-8811
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Fax |
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Provider Business Mailing Address
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Address Line | 3818 NORTHLAKE CREEK DR
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City | TUCKER
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State | GA
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Zip | 30084-3418
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Country | US
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Telephone | 404-988-8811
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | CRYSTAL WHITE
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Credential |
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Telephone | 404-988-8811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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