Provider Demographics
NPI:1952111981
Name:NCR MEDICAL LAB
Entity type:Organization
Organization Name:NCR MEDICAL LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:CHINEYE
Authorized Official - Last Name:RENFROE
Authorized Official - Suffix:
Authorized Official - Credentials:HT(ASCP) CM, CPT
Authorized Official - Phone:877-822-2349
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-11
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No246QH0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHistologyGroup - Multi-Specialty
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Multi-Specialty