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General NPI Number Information
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NPI Number | 1316832629
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Entity Type | Organization
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Legal Business Name | SPECIMEN COMPLIANCE GROUP
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 627 MILLRUN CT
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City | MACON
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State | GA
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Zip | 31210
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Country | US
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Telephone | 803-236-5333
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Fax |
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Provider Business Mailing Address
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Address Line | 1302 WATSON BLVD
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City | WARNER ROBINS
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State | GA
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Zip | 31093-3436
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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 | JONIECE DORSEY
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Credential |
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Telephone | 803-236-5333
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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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Taxonomy #2
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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