Provider Demographics
NPI:1780494716
Name:RENFROE, NAOMI CHINEYE (HT(ASCP) CM, CPT)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:CHINEYE
Last Name:RENFROE
Suffix:
Gender:
Credentials:HT(ASCP) CM, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 N JOHNSTON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-4741
Mailing Address - Country:US
Mailing Address - Phone:877-822-2349
Mailing Address - Fax:877-341-4313
Practice Address - Street 1:168 N JOHNSTON ST STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-4741
Practice Address - Country:US
Practice Address - Phone:877-822-2349
Practice Address - Fax:877-341-4313
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-11
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA26708246QH0600X
246RM2200X, 246RP1900X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No246QH0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHistology
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy