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General NPI Number Information
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NPI Number | 1497369045
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Entity Type | Organization
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Legal Business Name | PCR-DX, LLC
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 720 MAIN ST SW STE D
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City | GAINESVILLE
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State | GA
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Zip | 30501-4400
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Country | US
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Telephone | 205-861-1951
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 70608
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City | TUSCALOOSA
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State | AL
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Zip | 35407-0608
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Country | US
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Telephone | 205-861-1951
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GRADY PHILLIPS
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Credential |
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Telephone | 205-861-1951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SM0001X
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Taxonomy Name | Molecular Genetic Pathology (Medical Genetics) Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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