Provider Demographics
NPI:1114344983
Name:INTELLIGENETICS, LLC
Entity Type:Organization
Organization Name:INTELLIGENETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, HR
Authorized Official - Prefix:
Authorized Official - First Name:JANUARY
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-819-4500
Mailing Address - Street 1:3480 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-1700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 NEW ORLEANS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29928-4721
Practice Address - Country:US
Practice Address - Phone:334-819-4500
Practice Address - Fax:334-819-4520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8038983432291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory