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General NPI Number Information
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NPI Number | 1497829279
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Entity Type | Organization
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Legal Business Name | CITIZEN'S DIAGNOSTIC LABORATORY
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 03/24/2009
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Provider Practice Location Address
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Address Line | 5860 LOVE ST
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City | AUSTELL
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State | GA
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Zip | 30168-4044
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Country | US
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Telephone | 770-941-5151
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Fax | 770-941-5152
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Provider Business Mailing Address
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Address Line | PO BOX 1406
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City | AUSTELL
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State | GA
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Zip | 30168-1057
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Country | US
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Telephone | 770-941-5151
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Fax | 770-941-5152
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Authorized Official
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Title or Position | MEDICAL TECHNOLOGIST
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Name | MR. NIXON UKENNA ONYIRIMBA
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Credential |
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Telephone | 770-941-5151
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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 | GA
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