Provider Demographics
NPI:1467292235
Name:INTEGRITY GARDEN DIAGNOSTIC AND LAB LLC
Entity type:Organization
Organization Name:INTEGRITY GARDEN DIAGNOSTIC AND LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAGITTARIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:CONERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-703-1387
Mailing Address - Street 1:2763 HIGHWAY 138 E STE A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2763
Mailing Address - Country:US
Mailing Address - Phone:770-703-1387
Mailing Address - Fax:770-302-0380
Practice Address - Street 1:2763 HIGHWAY 138 E STE A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2763
Practice Address - Country:US
Practice Address - Phone:770-703-1387
Practice Address - Fax:770-302-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory