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General NPI Number Information
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NPI Number | 1417816935
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Entity Type | Organization
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Legal Business Name | PONYA DIAGNOSTICS OF OKLAHOMA LLC
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Dates
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Enumeration Date | 01/20/2026
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 6312 E 101ST ST
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City | TULSA
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State | OK
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Zip | 74137-7007
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Country | US
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Telephone | 229-442-7210
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Fax |
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Provider Business Mailing Address
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Address Line | 13 CORPORATE BLVD NE STE 250
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City | BROOKHAVEN
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State | GA
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Zip | 30329-1901
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Country | US
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Telephone | 229-442-7210
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Fax | 404-759-2019
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Authorized Official
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Title or Position | OWNER
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Name | MEKONNEN ABEBE
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Credential |
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Telephone | 229-442-7210
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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 |
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License Number State |
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