Provider Demographics
NPI:1497829279
Name:CITIZEN'S DIAGNOSTIC LABORATORY
Entity Type:Organization
Organization Name:CITIZEN'S DIAGNOSTIC LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:NIXON
Authorized Official - Middle Name:UKENNA
Authorized Official - Last Name:ONYIRIMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-941-5151
Mailing Address - Street 1:PO BOX 1406
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-1057
Mailing Address - Country:US
Mailing Address - Phone:770-941-5151
Mailing Address - Fax:770-941-5152
Practice Address - Street 1:5860 LOVE ST
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-4044
Practice Address - Country:US
Practice Address - Phone:770-941-5151
Practice Address - Fax:770-941-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory