Provider Demographics
NPI:1528233038
Name:KLA MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:KLA MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:BONNIE
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-320-0230
Mailing Address - Street 1:1214 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-2538
Mailing Address - Country:US
Mailing Address - Phone:706-320-0230
Mailing Address - Fax:706-221-7136
Practice Address - Street 1:1214 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2538
Practice Address - Country:US
Practice Address - Phone:706-320-0230
Practice Address - Fax:706-221-7136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA252324251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health