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General NPI Number Information
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NPI Number | 1528704830
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Entity Type | Organization
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Legal Business Name | AG SCREENING LAB, LLC
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 108A E MAIN ST
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City | LATTA
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State | SC
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Zip | 29565-1617
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Country | US
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Telephone | 843-418-1197
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Fax | 843-418-1097
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Provider Business Mailing Address
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Address Line | 108A E MAIN ST
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City | LATTA
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State | SC
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Zip | 29565-1617
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Country | US
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Telephone | 843-418-1197
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Fax | 843-418-1097
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Authorized Official
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Title or Position | OWNER
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Name | MS. LOMETRIA WILSON
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Credential |
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Telephone | 843-616-8770
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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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