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General NPI Number Information
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NPI Number | 1326369372
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Entity Type | Organization
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Legal Business Name | G & G DIAGNOSTIC, LLC
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Dates
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Enumeration Date | 06/14/2010
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Last Update Date | 06/14/2010
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Provider Practice Location Address
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Address Line | 7410 NEW LAGRANGE RD SUITE 202
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City | LOUISVILLE
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State | KY
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Zip | 40222
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Country | US
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Telephone | 859-806-4778
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Fax |
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Provider Business Mailing Address
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Address Line | 373 HAYS BLVD
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City | LEXINGTON
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State | KY
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Zip | 40509-4495
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Country | US
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Telephone | 859-806-4778
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GARY D COFFELT
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Credential |
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Telephone | 859-806-4778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | C01 508 809
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License Number State | KY
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