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General NPI Number Information
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NPI Number | 1881979888
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Entity Type | Organization
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Legal Business Name | GALAXY DIAGNOSTICS, INC.
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Dates
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Enumeration Date | 10/21/2011
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 7020 KIT CREEK RD SUITE 130
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City | MORRISVILLE
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State | NC
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Zip | 27560-9761
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Country | US
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Telephone | 919-313-9672
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Fax | 919-287-2476
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Provider Business Mailing Address
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Address Line | PO BOX 14346 7020 KIT CREEK RD, SUITE 130
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City | RESEARCH TRIANGLE PARK
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State | NC
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Zip | 27709-4346
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Country | US
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Telephone | 919-313-9672
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Fax | 919-287-2476
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMANDA B. ELAM
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Credential | PHD
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Telephone | 919-313-9672
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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 | 34D2027997
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License Number State | NC
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