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General NPI Number Information
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NPI Number | 1780178764
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Entity Type | Organization
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Legal Business Name | LIFESPRING LABORATORIES
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 2200 GARRISON BLVD STE 3013
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City | BALTIMORE
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State | MD
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Zip | 21216
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Country | US
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Telephone | 678-561-2140
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 HIGHWAY 85 N STE 310-406
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7738
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Country | US
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Telephone | 678-561-3037
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Fax | 667-260-6180
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Authorized Official
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Title or Position | OWNER
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Name | DONALD WILSON
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Credential |
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Telephone | 678-561-3037
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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 | 21D2149021
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License Number State | MD
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