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General NPI Number Information
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NPI Number | 1386076388
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Entity Type | Organization
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Legal Business Name | VEDRUS LABORATORIES
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Dates
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Enumeration Date | 08/01/2013
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Last Update Date | 08/01/2013
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Provider Practice Location Address
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Address Line | 175 HANDLEY RD SUITE 200
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City | TYRONE
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State | GA
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Zip | 30290-2155
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Country | US
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Telephone | 770-681-0779
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Fax | 678-489-2907
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Provider Business Mailing Address
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Address Line | 175 HANDLEY RD SUITE 200
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City | TYRONE
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State | GA
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Zip | 30290-2155
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Country | US
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Telephone | 770-681-0779
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Fax | 678-489-2907
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DANA PIERCE
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Credential | LAB TECHNICIAN
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Telephone | 770-681-0779
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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 | 056-010
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License Number State | GA
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