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General NPI Number Information
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NPI Number | 1427649680
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Entity Type | Organization
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Legal Business Name | ELITE MEDICAL LABS,LLC
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Dates
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Enumeration Date | 01/31/2021
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Last Update Date | 03/01/2021
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Provider Practice Location Address
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Address Line | 3722 STONEBRANCH LANE
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City | LOGANVILLE
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State | GA
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Zip | 30052
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Country | US
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Telephone | 314-630-5310
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Fax | 888-398-3036
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Provider Business Mailing Address
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Address Line | 3722 STONEBRANCH LANE
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City | LOGANVILLE
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State | GA
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Zip | 30052
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Country | US
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Telephone | 314-630-5310
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Fax | 888-398-3036
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Authorized Official
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Title or Position | OWNER
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Name | OOUIDA C YOUNG
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Credential | RN
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Telephone | 314-630-5310
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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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