| NPI | 1780338517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACI SLACK Chief Executive Officer 678-387-9409 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| 291900000X Military Clinical Medical Laboratory | |
| Enumeration Date | 2022-02-10 |
| Last Update Date | 2025-09-02 |