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General NPI Number Information
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NPI Number | 1417283458
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Entity Type | Organization
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Legal Business Name | ALL CLINICAL LABS
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 155 WESTRIDGE PARKWAY 102
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City | MCDONOUGH
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State | GA
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Zip | 30253
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Country | US
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Telephone | 770-957-3103
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Fax | 770-957-3141
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Provider Business Mailing Address
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Address Line | 155 WESTRIDGE PKWY 102
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City | MCDONOUGH
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State | GA
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Zip | 30253-3049
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Country | US
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Telephone | 770-957-3103
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Fax | 770-957-3141
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Authorized Official
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Title or Position | CEO
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Name | MRS. LORRIE E GRIER
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Credential | CPT
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Telephone | 770-957-3103
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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 | 26641
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License Number State | GA
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