Provider Demographics
NPI:1215633185
Name:PIEDMONT LABS, CORP
Entity type:Organization
Organization Name:PIEDMONT LABS, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-910-9116
Mailing Address - Street 1:3069 AMWILER RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30360-2825
Mailing Address - Country:US
Mailing Address - Phone:404-910-9116
Mailing Address - Fax:
Practice Address - Street 1:3069 AMWILER RD STE 1
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30360-2825
Practice Address - Country:US
Practice Address - Phone:404-910-9116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory