MEDICARE: CENTRAL GEORGIA DRUG & DNA TESTING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343800000X	Secured Medical Transport (VAN)
2	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1134082969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL GEORGIA DRUG & DNA TESTING

Provider Business Mailing Address
First Line	:	110 ANNA CLAIRE WAY
Second Line	:
City	:	PERRY
State	:	GA
Zip	:	31069-9482
Country	:	US
Telephone Number	:	478-758-1125
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 ANNA CLAIRE WAY
Second Line	:
City	:	PERRY
State	:	GA
Zip	:	31069-9482
Country	:	US
Telephone Number	:	478-758-1125
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	PRINCESS JACKSON
Credential	:
Telephone Number	:	478-758-1125

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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