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General NPI Number Information
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NPI Number | 1902471691
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Entity Type | Organization
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Legal Business Name | LEVERAGE LABS LLC
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 2330 SCENIC HWY S STE 225
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City | SNELLVILLE
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State | GA
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Zip | 30078-3115
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Country | US
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Telephone | 470-772-1848
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Fax |
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Provider Business Mailing Address
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Address Line | 2330 SCENIC HWY S STE 225
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City | SNELLVILLE
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State | GA
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Zip | 30078-3115
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Country | US
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Telephone | 470-772-1848
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS WHITNEY SHANEE' FEDRICK
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Credential | CPT
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Telephone | 470-772-1848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number |
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License Number State |
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