Provider Demographics
NPI:1205173770
Name:DUCKWORTH LABORATORIES INC.
Entity type:Organization
Organization Name:DUCKWORTH LABORATORIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICETR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:CHCO
Authorized Official - Phone:901-725-7551
Mailing Address - Street 1:1211 UNION AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6638
Mailing Address - Country:US
Mailing Address - Phone:901-725-7551
Mailing Address - Fax:901-725-9721
Practice Address - Street 1:1211 UNION AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6638
Practice Address - Country:US
Practice Address - Phone:901-725-7551
Practice Address - Fax:901-725-9721
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DUCKWORTH PATHOLOGY GROUP INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-03
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3282207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty