=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376401745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRESTIGE MOBILE PHLEBOTOMY SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2026
-----------------------------------------------------
Last Update Date | 01/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 174 STEPHENS DR
-----------------------------------------------------
City | DRY BRANCH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31020-3622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-245-0628
-----------------------------------------------------
Fax | 478-245-0628
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 174 STEPHENS DR
-----------------------------------------------------
City | DRY BRANCH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31020-3622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-245-0628
-----------------------------------------------------
Fax | 478-245-0628
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL ASSISTANT
-----------------------------------------------------
Name | CRYSTAL LOWANDA THOMAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 478-245-0628
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246RP1900X
-----------------------------------------------------
Taxonomy Name | Phlebotomy Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------