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General NPI Number Information
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NPI Number | 1659101517
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Entity Type | Organization
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Legal Business Name | DIVINE TRINITY MOBILE LAB & CPR SERVICES, LLC
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Dates
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Enumeration Date | 08/06/2024
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 6213 W FAYETTEVILLE RD
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City | RIVERDALE
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State | GA
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Zip | 30296-2953
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Country | US
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Telephone | 470-800-5251
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Fax |
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Provider Business Mailing Address
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Address Line | 1445 WOODMONT LN NW STE 3334
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City | ATLANTA
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State | GA
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Zip | 30318-2866
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Country | US
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Telephone | 470-800-5251
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | GLORIA RODGERS
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Credential |
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Telephone | 470-800-5251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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