Provider Demographics
NPI:1679245211
Name:JOHN, VERNON (DRUG/DNA COLLECTOR)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:DRUG/DNA COLLECTOR
Other - Prefix:
Other - First Name:VERNON
Other - Middle Name:
Other - Last Name:MOREAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:146 RAILROAD ST STE B
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-2749
Mailing Address - Country:US
Mailing Address - Phone:706-990-9877
Mailing Address - Fax:
Practice Address - Street 1:146 RAILROAD ST STE B
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-2749
Practice Address - Country:US
Practice Address - Phone:888-893-0935
Practice Address - Fax:352-664-2523
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician