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General NPI Number Information
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NPI Number | 1477207934
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Entity Type | Organization
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Legal Business Name | RN ON WHEELS-MOBILIZED DIAGNOSTIC TESTING & HEALTHCARE SERVICE
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 3616 PHYLLIS CT
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City | HEPHZIBAH
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State | GA
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Zip | 30815-6216
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Country | US
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Telephone | 706-589-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 3616 PHYLLIS CT
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City | HEPHZIBAH
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State | GA
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Zip | 30815-6216
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Country | US
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Telephone | 706-589-3100
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | JACQUELINE Y ROGERS
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Credential | RN-BSN
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Telephone | 706-589-3100
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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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