Provider Demographics
NPI:1063028991
Name:ATLAS EPIGENETICS
Entity type:Organization
Organization Name:ATLAS EPIGENETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-655-1801
Mailing Address - Street 1:3311 N UNIVERSITY AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-7431
Mailing Address - Country:US
Mailing Address - Phone:801-655-1801
Mailing Address - Fax:385-225-8201
Practice Address - Street 1:3311 N UNIVERSITY AVE STE 150
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-7431
Practice Address - Country:US
Practice Address - Phone:801-655-1801
Practice Address - Fax:385-225-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty