Provider Demographics
NPI:1477207934
Name:RN ON WHEELS-MOBILIZED DIAGNOSTIC TESTING & HEALTHCARE SERVICE
Entity Type:Organization
Organization Name:RN ON WHEELS-MOBILIZED DIAGNOSTIC TESTING & HEALTHCARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BSN
Authorized Official - Phone:706-589-3100
Mailing Address - Street 1:3616 PHYLLIS CT
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-6216
Mailing Address - Country:US
Mailing Address - Phone:706-589-3100
Mailing Address - Fax:
Practice Address - Street 1:3616 PHYLLIS CT
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-6216
Practice Address - Country:US
Practice Address - Phone:706-589-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory