Organization
COMPLETE WELLNESS DIAGNOSTIC LAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARNIKA PORTER (OWNER/ADMINISTRATOR)
(678) 643-0885
Entity
Organization
Contact information
Practice address
1514 RIVERBROOKE WAY NE, CONYERS, GA 30012-6624
(678) 643-0885
Mailing address
1514 RIVERBROOKE WAY NE, CONYERS, GA 30012-6624
(678) 643-0885
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
03/15/2022
Last updated
03/15/2022
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