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General NPI Number Information
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NPI Number | 1861925075
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Entity Type | Organization
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Legal Business Name | NOMADX INC.
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 4 E WASHINGTON ST STE B2-B4
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City | NEWNAN
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State | GA
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Zip | 30263-1933
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Country | US
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Telephone | 404-826-9729
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Fax |
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Provider Business Mailing Address
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Address Line | 18 VANDERBILT POINTE WAY
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City | NEWNAN
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State | GA
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Zip | 30265-2307
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Country | US
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Telephone | 404-826-9729
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEREK LUCCHESI
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Credential | ARRT
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Telephone | 404-372-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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