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General NPI Number Information
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NPI Number | 1578040630
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Entity Type | Organization
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Legal Business Name | INVICTA LABORATORIES LLC
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Dates
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Enumeration Date | 07/22/2018
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 312 NANCY LYNN LN STE 2
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City | KNOXVILLE
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State | TN
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Zip | 37919-6046
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Country | US
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Telephone | 865-776-6258
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Fax | 865-312-9662
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Provider Business Mailing Address
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Address Line | 312 NANCY LYNN LN STE 2
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City | KNOXVILLE
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State | TN
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Zip | 37919-6046
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Country | US
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Telephone | 865-985-0945
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Fax | 865-312-9662
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Authorized Official
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Title or Position | OWNER
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Name | MR. LOGANATHAN DORAISAMY
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Credential |
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Telephone | 858-472-5590
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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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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 | TN
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