Provider Demographics
NPI:1629964721
Name:PONYA DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:PONYA DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MEKONNEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-956-5959
Mailing Address - Street 1:13 CORPORATE BLVD NE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1901
Mailing Address - Country:US
Mailing Address - Phone:404-956-5959
Mailing Address - Fax:404-521-4323
Practice Address - Street 1:13 CORPORATE BLVD NE STE 100
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-1905
Practice Address - Country:US
Practice Address - Phone:404-956-5959
Practice Address - Fax:404-521-4323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-16
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory