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General NPI Number Information
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NPI Number | 1952111981
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Entity Type | Organization
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Legal Business Name | NCR MEDICAL LAB
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Dates
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Enumeration Date | 01/11/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 168 N JOHNSTON ST STE 300
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City | DALLAS
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State | GA
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Zip | 30132-4741
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Country | US
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Telephone | 877-822-2349
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Fax | 877-341-4313
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Provider Business Mailing Address
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Address Line | 168 N JOHNSTON ST STE 300
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City | DALLAS
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State | GA
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Zip | 30132-4741
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Country | US
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Telephone | 877-822-2349
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Fax | 877-341-4313
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Authorized Official
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Title or Position | OWNER
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Name | NAOMI CHINEYE RENFROE
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Credential | HT(ASCP) CM, CPT
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Telephone | 877-822-2349
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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 |
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