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General NPI Number Information
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NPI Number | 1750752580
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Entity Type | Organization
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Legal Business Name | CCRM ATLANTA, LLC
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 5909 PEACHTREE DUNWOODY RD SUITE 720
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City | ATLANTA
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State | GA
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Zip | 30328-8102
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Country | US
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Telephone | 303-908-9375
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Fax |
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Provider Business Mailing Address
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Address Line | 9800 MT PYRAMID CT SUITE 400
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City | ENGLEWOOD
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State | CO
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Zip | 80112-5999
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Country | US
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Telephone | 303-908-9375
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Fax |
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Authorized Official
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Title or Position | BUSINESS DEVELOPMENT
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Name | SCOTT PORTNOY
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Credential |
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Telephone | 303-908-9375
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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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