Provider Demographics
NPI:1104607670
Name:SOLOMON'S LABORATORY AND GENETIC TESTING, LLC
Entity type:Organization
Organization Name:SOLOMON'S LABORATORY AND GENETIC TESTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-304-6235
Mailing Address - Street 1:2881 N CANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-9124
Mailing Address - Country:US
Mailing Address - Phone:412-304-6235
Mailing Address - Fax:
Practice Address - Street 1:2881 N CANNON BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-9124
Practice Address - Country:US
Practice Address - Phone:412-304-6235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center