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General NPI Number Information
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NPI Number | 1669391900
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Entity Type | Organization
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Legal Business Name | KM MOBILE LAB ENTERPRISES LLC
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Dates
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Enumeration Date | 07/11/2026
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Last Update Date | 07/11/2026
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Provider Practice Location Address
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Address Line | 318 HOSPITAL DR
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City | THOMSON
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State | GA
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Zip | 30824-2121
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Country | US
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Telephone | 706-843-7275
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Fax | 706-426-8469
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Provider Business Mailing Address
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Address Line | 5121 WASHINGTON ROAD STE 2 #1019
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City | EVANS
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State | GA
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Zip | 30809
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Country | US
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Telephone | 706-843-7275
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Fax | 706-426-8469
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Authorized Official
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Title or Position | OWNER
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Name | KYANNA NICOLE MULLEN
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Credential |
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Telephone | 762-218-3929
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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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