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General NPI Number Information
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NPI Number | 1639777899
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Entity Type | Organization
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Legal Business Name | WHITE COAT SCIENCES LLC
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Dates
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Enumeration Date | 10/11/2020
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Last Update Date | 10/11/2020
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Provider Practice Location Address
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Address Line | 315 BANKHEAD HWY STE A
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City | CARROLLTON
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State | GA
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Zip | 30117-2487
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Country | US
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Telephone | 404-436-0009
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Fax | 470-531-1323
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Provider Business Mailing Address
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Address Line | 315 BANKHEAD HWY STE A
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City | CARROLLTON
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State | GA
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Zip | 30117-2487
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Country | US
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Telephone | 404-436-0009
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Fax | 470-531-1323
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRENT A HARRIS
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Credential | MD
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Telephone | 404-796-5898
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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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