Provider Demographics
NPI:1467904334
Name:DIAGNOSTIC GO MOBILE
Entity Type:Organization
Organization Name:DIAGNOSTIC GO MOBILE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNE/ PHLEBOTOMY
Authorized Official - Prefix:
Authorized Official - First Name:TAWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-613-9802
Mailing Address - Street 1:922 HIGHWAY 81 E
Mailing Address - Street 2:STE 236
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-2978
Mailing Address - Country:US
Mailing Address - Phone:678-613-9802
Mailing Address - Fax:770-957-1287
Practice Address - Street 1:922 HIGHWAY 81 E
Practice Address - Street 2:STE 236
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-2978
Practice Address - Country:US
Practice Address - Phone:678-613-9802
Practice Address - Fax:770-957-1287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty