Provider Demographics
NPI:1972192045
Name:MOBILE LAB TESTING BY CHERESE
Entity Type:Organization
Organization Name:MOBILE LAB TESTING BY CHERESE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-231-7551
Mailing Address - Street 1:1656 WARE AVE # 130
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3133
Mailing Address - Country:US
Mailing Address - Phone:678-670-7200
Mailing Address - Fax:
Practice Address - Street 1:1656 WARE AVE # 130
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3133
Practice Address - Country:US
Practice Address - Phone:678-670-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory