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NPI Code Detail

MEDICARE: PERNICIARO LABORATORIES OF GEORGIA PC

MEDICARE: PERNICIARO LABORATORIES OF GEORGIA PC
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
1291U00000XClinical Medical LaboratoryGA

General Provider Information

NPI Number : 1962503037
Entity Type Code : Organization
Provider Name (Legal Business Name) : PERNICIARO LABORATORIES OF GEORGIA PC
Provider Business Mailing Address
First Line : 3008 E PARK AVE
Second Line :
City : BRUNSWICK
State : GA
Zip : 31520-4241
Country : US
Telephone Number : 912-265-2142
Fax Number : 912-265-0530
Provider Business Practice Location Address
First Line : 3008 E PARK AVE
Second Line :
City : BRUNSWICK
State : GA
Zip : 31520-4241
Country : US
Telephone Number : 912-265-2142
Fax Number : 912-265-0530
Authorized Official
Title or Position : PRESIDENT
Name : CHARLES V PERNICIARO
Credential : M.D.
Telephone Number : 912-265-2142
Provider Enumeration Date : 09/25/2006
Last Update Date : 08/22/2020

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Directions to “PERNICIARO LABORATORIES OF GEORGIA PC ” Practice Location

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