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General NPI Number Information
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NPI Number | 1497175905
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Entity Type | Organization
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Legal Business Name | ISPM LABS, LLC
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 8601 DUNWOODY PL STE 444
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City | ATLANTA
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State | GA
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Zip | 30350
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Country | US
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Telephone | 678-515-4524
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 743943
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City | ATLANTA
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State | GA
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Zip | 30374-3943
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Country | US
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Telephone | 678-515-4524
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANDREW MALONEY
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Credential |
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Telephone | 678-515-4524
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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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