# ANCIENT CITY DIAGNOSTICS, LLC

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

## Provider details

- **NPI number:** 1629604046
- **Authorized official:** CHRISTOPHER EDMONDSON (OWNER)
- **Authorized official phone:** (904) 439-3414

## Contact information

- **Practice address:** 150 SOUTHPARK BLVD STE 206, SAINT AUGUSTINE, FL 32086-5179
- **Practice address phone:** (904) 439-3414
- **Mailing address:** 8563 ARGYLE BUSINESS LOOP STE 5, JACKSONVILLE, FL 32244-6613
- **Mailing address phone:** (904) 439-3414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 291900000X | Military Clinical Medical Laboratory | — | NULL | Yes |

## Other

- **Enumeration date:** 03/17/2020
- **Last updated:** 03/17/2020