Provider Demographics
NPI:1679222327
Name:RESET DIAGNOSTIC LLC
Entity Type:Organization
Organization Name:RESET DIAGNOSTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHEENA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-971-0610
Mailing Address - Street 1:1301 ROUND ROCK CT
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-6505
Mailing Address - Country:US
Mailing Address - Phone:215-971-0610
Mailing Address - Fax:
Practice Address - Street 1:1301 ROUND ROCK CT
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-6505
Practice Address - Country:US
Practice Address - Phone:215-971-0610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory