Provider Demographics
NPI:1336892157
Name:NDS LABS
Entity Type:Organization
Organization Name:NDS LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:TERRI
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-454-6530
Mailing Address - Street 1:475 QUEEN ALIESE LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1727
Mailing Address - Country:US
Mailing Address - Phone:404-454-6530
Mailing Address - Fax:
Practice Address - Street 1:7740 ROSWELL RD STE 800A
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-6893
Practice Address - Country:US
Practice Address - Phone:404-399-9130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory