Provider Demographics
NPI:1326369372
Name:G & G DIAGNOSTIC, LLC
Entity type:Organization
Organization Name:G & G DIAGNOSTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:COFFELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-806-4778
Mailing Address - Street 1:373 HAYS BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4495
Mailing Address - Country:US
Mailing Address - Phone:859-806-4778
Mailing Address - Fax:
Practice Address - Street 1:7410 NEW LAGRANGE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:859-806-4778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYC01 508 809347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle