Provider Demographics
NPI:1154946101
Name:STATE DRUG TESTING & OCCUPATIONAL HEALTH, INC.
Entity type:Organization
Organization Name:STATE DRUG TESTING & OCCUPATIONAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-446-1777
Mailing Address - Street 1:PO BOX 18240
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31418-0240
Mailing Address - Country:US
Mailing Address - Phone:912-446-1777
Mailing Address - Fax:
Practice Address - Street 1:24 W CHATHAM CT
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-3051
Practice Address - Country:US
Practice Address - Phone:912-446-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine