MEDICARE: FOXX LABORATORIES AND SCREENING

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1639822083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOXX LABORATORIES AND SCREENING

Provider Business Mailing Address
First Line	:	3774 RIVER ROCK RD
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30038-3383
Country	:	US
Telephone Number	:	470-350-4396
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 SANDY PLAINS RD STE 101
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-4290
Country	:	US
Telephone Number	:	470-487-2245
Fax Number	:	678-623-8880

Authorized Official
Title or Position	:	OWNER
Name	:	SHARISMA SONYA GEORGE
Credential	:
Telephone Number	:	470-350-4396

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	01/26/2022

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