Provider Demographics
NPI:1902645260
Name:PRETTYSTICKS MOBILE PHLEBOTOMY CONCIERGE
Entity type:Organization
Organization Name:PRETTYSTICKS MOBILE PHLEBOTOMY CONCIERGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KETRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARSON
Authorized Official - Suffix:
Authorized Official - Credentials:NCPT, CPI
Authorized Official - Phone:757-679-7134
Mailing Address - Street 1:501 HARVICK CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4457
Mailing Address - Country:US
Mailing Address - Phone:757-679-7134
Mailing Address - Fax:
Practice Address - Street 1:8735 DUNWOODY PL # 5992
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-2995
Practice Address - Country:US
Practice Address - Phone:757-679-7134
Practice Address - Fax:770-809-5077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Multi-Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty