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General NPI Number Information
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NPI Number | 1649056250
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Entity Type | Organization
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Legal Business Name | FREEDOM MOBILE PHLEBOTOMY
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Dates
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Enumeration Date | 09/08/2023
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 1790 PINEHURST VIEW DR
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City | GRAYSON
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State | GA
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Zip | 30017-7910
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Country | US
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Telephone | 404-804-0741
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Fax |
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Provider Business Mailing Address
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Address Line | 1790 PINEHURST VIEW DR
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City | GRAYSON
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State | GA
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Zip | 30017-7910
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Country | US
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Telephone | 404-804-0741
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Fax |
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Authorized Official
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Title or Position | PHLEBOTOMIST CEO
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Name | SHALAYA GRAY
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Credential | MA
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Telephone | 404-804-0741
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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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