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General NPI Number Information
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NPI Number | 1508501941
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Entity Type | Organization
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Legal Business Name | PM LAB SOURCE
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Dates
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Enumeration Date | 04/30/2022
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Last Update Date | 04/30/2022
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Provider Practice Location Address
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Address Line | 8201 PRESERVATION TRL
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City | MIDLAND
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State | GA
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Zip | 31820-3667
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Country | US
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Telephone | 706-914-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 8201 PRESERVATION TRL
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City | MIDLAND
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State | GA
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Zip | 31820-3667
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Country | US
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Telephone | 706-914-8400
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | PATRICIA MCLAUGHLIN
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Credential | NP
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Telephone | 706-914-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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