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General NPI Number Information
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NPI Number | 1518728237
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Entity Type | Organization
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Legal Business Name | RESONANCE LABORATORIES LLC
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Dates
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Enumeration Date | 01/19/2024
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 729 E PASS RD STE G
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City | GULFPORT
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State | MS
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Zip | 39507-3305
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Country | US
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Telephone | 770-318-0476
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Fax |
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Provider Business Mailing Address
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Address Line | 950 HERRINGTON RD # 64
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-7217
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Country | US
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Telephone | 770-318-0476
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | AVERIL JOHNSON
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Credential |
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Telephone | 770-318-0476
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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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