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General NPI Number Information
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NPI Number | 1356773436
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Entity Type | Organization
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Legal Business Name | MEDALERT,LLC
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 1240 HIGHWAY 54 W SUITE 102
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4557
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Country | US
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Telephone | 770-892-1821
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Fax |
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Provider Business Mailing Address
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Address Line | 1240 HIGHWAY 54 W SUITE 102
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4557
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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 | ADMINISTRATOR
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Name | PATRICK OGBEBOR
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Credential |
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Telephone | 770-892-1821
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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 | 2266
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License Number State | GA
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