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General NPI Number Information
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NPI Number | 1407850985
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Entity Type | Organization
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Legal Business Name | SOLSTAS LAB PARTNERS GROUP LLC
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 2906 JULIA DR
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City | VALDOSTA
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State | GA
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Zip | 31602-1435
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Country | US
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Telephone | 229-244-4468
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Fax | 229-249-8191
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Provider Business Mailing Address
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Address Line | 1201 S COLLEGEVILLE RD
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City | COLLEGEVILLE
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State | PA
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Zip | 19146-2998
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Country | US
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Telephone | 610-454-6147
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Fax | 484-676-5309
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | WILSON CONDE
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Credential |
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Telephone | 800-227-0446
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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 | 092002
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License Number State | GA
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