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General NPI Number Information
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NPI Number | 1467292235
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Entity Type | Organization
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Legal Business Name | INTEGRITY GARDEN DIAGNOSTIC AND LAB LLC
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 2763 HIGHWAY 138 E STE A
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City | JONESBORO
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State | GA
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Zip | 30236-2763
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Country | US
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Telephone | 770-703-1387
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Fax | 770-302-0380
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Provider Business Mailing Address
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Address Line | 2763 HIGHWAY 138 E STE A
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City | JONESBORO
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State | GA
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Zip | 30236-2763
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Country | US
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Telephone | 770-703-1387
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Fax | 770-302-0380
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/OWNER
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Name | SAGITTARIUS CONERLY
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Credential |
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Telephone | 770-703-1387
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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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