Provider Demographics
NPI:1285816512
Name:MEDICAL TECHNOLOGIES
Entity Type:Organization
Organization Name:MEDICAL TECHNOLOGIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LATONAY
Authorized Official - Middle Name:W
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-386-4987
Mailing Address - Street 1:1105 20TH ST E
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-3668
Mailing Address - Country:US
Mailing Address - Phone:229-386-4987
Mailing Address - Fax:
Practice Address - Street 1:1105 20TH ST E
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3668
Practice Address - Country:US
Practice Address - Phone:229-386-4987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory