Provider Demographics
NPI:1194598219
Name:GUARDIAN RAPID LAB TESTING LLC
Entity type:Organization
Organization Name:GUARDIAN RAPID LAB TESTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:984-275-9863
Mailing Address - Street 1:101 FOREST DR STE B
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-9603
Mailing Address - Country:US
Mailing Address - Phone:984-275-9863
Mailing Address - Fax:
Practice Address - Street 1:101 FOREST DR STE B
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-9603
Practice Address - Country:US
Practice Address - Phone:984-275-9863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory