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General NPI Number Information
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NPI Number | 1558097592
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Entity Type | Organization
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Legal Business Name | PROTEUS GENOMICS, LLC
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Dates
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Enumeration Date | 07/30/2022
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Last Update Date | 07/30/2022
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Provider Practice Location Address
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Address Line | 6766 U S HIGHWAY 98 STE 1B
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City | HATTIESBURG
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State | MS
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Zip | 39402-8443
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Country | US
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Telephone | 601-549-4182
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Fax |
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Provider Business Mailing Address
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Address Line | 6766 U S HIGHWAY 98 STE 1B
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City | HATTIESBURG
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State | MS
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Zip | 39402-8443
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | MICHAEL GRIFFITH
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Credential |
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Telephone | 205-478-7302
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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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