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General NPI Number Information
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NPI Number | 1801851233
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Entity Type | Organization
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Legal Business Name | WOODBURY CLINICAL LABORATORY, INC.
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 305 E HIGH ST
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City | LEBANON
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State | TN
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Zip | 37087-2901
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Country | US
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Telephone | 615-443-7588
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Fax | 615-443-7458
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Provider Business Mailing Address
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Address Line | PO BOX 2309
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City | LEBANON
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State | TN
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Zip | 37088-2309
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Country | US
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Telephone | 615-443-7588
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Fax | 615-443-7458
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MRS. DELIA OLDHAM
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Credential |
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Telephone | 615-443-7588
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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 | 0000002135
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License Number State | TN
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