Provider Demographics
NPI:1770037160
Name:FAST AND ACCURATE TEST LABS
Entity Type:Organization
Organization Name:FAST AND ACCURATE TEST LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STALLWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-210-1093
Mailing Address - Street 1:1945 J N PEASE PL STE 102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4555
Mailing Address - Country:US
Mailing Address - Phone:980-210-1093
Mailing Address - Fax:704-510-1763
Practice Address - Street 1:1945 J N PEASE PL STE 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4555
Practice Address - Country:US
Practice Address - Phone:980-210-1093
Practice Address - Fax:704-510-1763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory