| NPI | 1124585336 |
|---|---|
| Other Name | ULTRA LAB TEST |
| Entity Type | Organization |
| Authorized Contact | JACOB CORNELIUS PARKER Specialist Technologist 601-329-1321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 293D00000X Physiological Laboratory |
| Additional Taxonomies | 103TP0814X Psychologist, Psychoanalysis |
| 246Z00000X Specialist/Technologist, Other | |
| 261QS1000X Clinic/Center, Student Health | |
| Enumeration Date | 2019-02-23 |
| Last Update Date | 2022-03-17 |