Provider Demographics
NPI:1609692128
Name:FIELD LABS DIAGNOSTICS
Entity type:Organization
Organization Name:FIELD LABS DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAULK
Authorized Official - Suffix:
Authorized Official - Credentials:CPT, CNA
Authorized Official - Phone:404-452-2817
Mailing Address - Street 1:35 SUMMER LEIGH DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5895
Mailing Address - Country:US
Mailing Address - Phone:404-452-2817
Mailing Address - Fax:
Practice Address - Street 1:804 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-7198
Practice Address - Country:US
Practice Address - Phone:404-452-2817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No293D00000XLaboratoriesPhysiological Laboratory