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General NPI Number Information
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NPI Number | 1568129179
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Entity Type | Organization
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Legal Business Name | ALLSTAR MOBILE LAB, LLC
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Dates
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Enumeration Date | 11/18/2021
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 1045 MCCALL ST
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City | HEPHZIBAH
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State | GA
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Zip | 30815-4660
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Country | US
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Telephone | 706-339-1603
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Fax |
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Provider Business Mailing Address
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Address Line | 1045 MCCALL ST
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City | HEPHZIBAH
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State | GA
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Zip | 30815-4660
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Country | US
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Telephone | 706-339-1603
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DENITA WALTOWER
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Credential | RN
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Telephone | 706-339-1603
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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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