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General NPI Number Information
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NPI Number | 1992819072
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Entity Type | Organization
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Legal Business Name | TRANS ALLIANCE LAB
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3050 MARTIN LUTHER KING JR DR SW STE H
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City | ATLANTA
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State | GA
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Zip | 30311-1500
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Country | US
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Telephone | 404-699-9000
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Fax | 404-699-9111
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Provider Business Mailing Address
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Address Line | PO BOX 767757
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City | ROSWELL
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State | GA
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Zip | 30076-7757
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Country | US
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Telephone | 404-699-9000
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Fax | 404-699-9111
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Authorized Official
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Title or Position | PHARMACIST
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Name | CHINWE BIBI NWABUDE
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Credential |
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Telephone | 404-699-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | PHRE008987
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License Number State | GA
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