=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982041521
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCURATE MEDICAL LAB INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2013
-----------------------------------------------------
Last Update Date | 01/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2023 16TH ST SUITE B
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27405-5119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-833-3367
-----------------------------------------------------
Fax | 434-688-0517
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 PARKER RD W SUITE A
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24540-7425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-833-3367
-----------------------------------------------------
Fax | 434-688-0517
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SAID ELFAYAR
-----------------------------------------------------
Credential | VMD, MBA
-----------------------------------------------------
Telephone | 336-833-3367
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 34D2057342
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------