# FIVE STAR DIAGNOSTICS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558894576
- **Authorized official:** CEDRIC SHANNON (OWNER/CEO)
- **Authorized official phone:** (205) 478-1200

## Contact information

- **Practice address:** 1028 GRANDE VIEW PASS, MAYLENE, AL 35114-4004
- **Practice address phone:** (205) 478-1200
- **Mailing address:** 1028 GRANDE VIEW PASS, MAYLENE, AL 35114-4004
- **Mailing address phone:** (205) 478-1200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |
| 252Y00000X | Early Intervention Provider Agency | — | NULL | — |

## Other

- **Enumeration date:** 04/06/2017
- **Last updated:** 02/27/2020