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General NPI Number Information
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NPI Number | 1366524563
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Entity Type | Organization
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Legal Business Name | LABORATORY SOUTH INC
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 189 W ATHENS ST
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City | WINDER
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State | GA
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Zip | 30680-2295
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Country | US
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Telephone | 770-270-9471
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Fax | 770-270-9470
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Provider Business Mailing Address
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Address Line | PO BOX 330
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City | WATKINSVILLE
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State | GA
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Zip | 30677-0009
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Country | US
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Telephone | 770-270-9471
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Fax | 770-270-9470
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Authorized Official
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Title or Position | OWNER
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Name | MARK T SPRINGER
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Credential |
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Telephone | 770-270-9471
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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 | 044134
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License Number State | GA
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