Provider Demographics
NPI:1225413099
Name:SOUTH GEORGIA TOXICOLOGY, INC
Entity Type:Organization
Organization Name:SOUTH GEORGIA TOXICOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAMBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-242-4600
Mailing Address - Street 1:3312 N OAK STREET EXT
Mailing Address - Street 2:B3
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-1065
Mailing Address - Country:US
Mailing Address - Phone:229-242-4600
Mailing Address - Fax:
Practice Address - Street 1:3312 N OAK STREET EXT
Practice Address - Street 2:B3
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1065
Practice Address - Country:US
Practice Address - Phone:229-242-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory