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General NPI Number Information
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NPI Number | 1831158757
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Entity Type | Organization
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Legal Business Name | NEXTWAVE DIAGNOSTIC LABORATORIES, LLC
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1915 S 17TH ST SUITE 100
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City | WILMINGTON
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State | NC
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Zip | 28401-6626
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Country | US
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Telephone | 910-202-2400
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Fax | 910-202-2499
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Provider Business Mailing Address
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Address Line | 1915 S 17TH ST SUITE 100
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City | WILMINGTON
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State | NC
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Zip | 28401-6626
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Country | US
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Telephone | 910-202-2400
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Fax | 910-202-2499
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/ PARTNER
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Name | DR. CHRISTOPHER D. MCKINNEY
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Credential | M.D.
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Telephone | 910-202-2400
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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 | NC
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