MOORE DIAGNOSTIC LABORATORY, INC. (NPI# 1629677034) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629677034 |
| Entity Type | Organization |
| Organization Name | MOORE DIAGNOSTIC LABORATORY, INC. |
| Practice Address |
5590 Mableton Pkwy Sw Ste 174 Mableton GA 30126-3303 |
| Practice Telephone | 6789200058 |
| Mailing Telephone | 6789200058 |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2020-10-19 |
| Authorized Official Name | MRS. MARLENE JUNE MOORE (PRESIDENT/CEO) |
| Authorized Official Telephone | 6789200058 |
| Authorized Official Credential | MT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 246QL0900X |
Spec/Tech, Pathology Specialization: Laboratory Management |
Technologists, Technicians & Other Technical Service Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MOORE DIAGNOSTIC LABORATORY, INC. | 1201 Laurel Cliff Dr Se, Smyrna, GA 30082-4323 |
| Street Address |
5590 MABLETON PKWY SW STE 174 |
| City | MABLETON |
| State | GA |
| Zip Code | 30126-3303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083256804 | Thelwell Immediate Care Clinic Inc | Clinic/Center | 1400 Veterans Memorial Highway Se Suite 134 #176, Mableton, GA 30126 | 2019-10-14 |
| 1467011049 | Iora Senior Health, Inc. | Internal Medicine | 5015 Floyd Rd, Suite 710, Mableton, GA 30126 | 2019-06-07 |
| 1649677626 | Wonderfully Made Wellness, Inc. | Specialist | 464 Vinings Vintage Circle Se, Mableton, GA 30126 | 2014-11-19 |
| 1811240633 | The Adult Resource Coalition | Community/Behavioral Health | 609 Hunnicut Rd, Mableton, GA 30126 | 2012-10-17 |
| 1922389253 | American Current Care Pa | Clinic/Center | 1025 Veterans Memorial, Mableton, GA 30126 | 2011-08-31 |
| 1558504308 | Eddie Joe Turner Jr. | Emergency Medicine | 4855 Floyd Rd Sw, Mableton, GA 30126 | 2009-04-09 |
| 1285881227 | Community Dental Services Inc | Dentist | 5761 Mableton Parkway, Mableton, GA 30126 | 2008-08-21 |
| 1396932281 | Kevin Duane Larry | Counselor | 1119 Silvergate Ln, Mableton, GA 30126 | 2007-09-25 |
| 1164634440 | Mableton Dental Inc | Dentist | 5841 Mableton Pkwy, Mableton, GA 30126 | 2007-05-07 |
| 1104038686 | Charles L Davenport Jr. | Pharmacist | 558 Ivey Way S.e., Mableton, GA 30126 | 2007-05-04 |
| Find all providers in zip 30126 | ||||
| Taxonomy Code | 246QL0900X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Spec/Tech, Pathology |
| Specialization | Laboratory Management |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346726122 | Myorganics | Spec/Tech, Pathology | 5910 Shadow Rock Dr, Lithonia, GA 30058 | 2018-07-16 |
| 1447780101 | Janetta Bryksin | Spec/Tech, Pathology | 1364 Clifton Rd Ne Rm F149, Atlanta, GA 30322-1059 | 2017-06-15 |
| 1528493434 | Bolanle George | Spec/Tech, Pathology | 5181 Pat Wiley Dr, Powder Springs, GA 30127-2457 | 2013-09-10 |
| 1477153955 | Peterson Alcide | Spec/Tech, Pathology | 166 Anderson St Se Ste 225, Marietta, GA 30060-1984 | 2020-10-26 |
| 1003392259 | Shanelle Lewis | Spec/Tech, Pathology | 4484 Covington Hwy, Decatur, GA 30035 | 2018-07-11 |
| 1932509544 | Jeffrey Baker | Spec/Tech, Pathology | 1061 Harmon Ave, Fort Stewart, GA 31314-5641 | 2014-09-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.