Provider Demographics
NPI:1386076388
Name:VEDRUS LABORATORIES
Entity type:Organization
Organization Name:VEDRUS LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:LAB TECHNICIAN
Authorized Official - Phone:770-681-0779
Mailing Address - Street 1:175 HANDLEY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2155
Mailing Address - Country:US
Mailing Address - Phone:770-681-0779
Mailing Address - Fax:678-489-2907
Practice Address - Street 1:175 HANDLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2155
Practice Address - Country:US
Practice Address - Phone:770-681-0779
Practice Address - Fax:678-489-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056-010291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory