Provider Demographics
NPI:1184472441
Name:BLOOD DIAMOND MOBILE LABORATORY LLC
Entity type:Organization
Organization Name:BLOOD DIAMOND MOBILE LABORATORY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHLEBOTOMIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROXANN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOOLING
Authorized Official - Suffix:
Authorized Official - Credentials:CPT, CCMA, CMA, CNA
Authorized Official - Phone:770-875-3947
Mailing Address - Street 1:889 COMMERCE DR SW STE C
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6624
Mailing Address - Country:US
Mailing Address - Phone:770-762-6019
Mailing Address - Fax:770-790-0050
Practice Address - Street 1:1212 RIVER RUSH LN NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-6613
Practice Address - Country:US
Practice Address - Phone:770-875-3947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty