Organization
PERSONAL GENOME DIAGNOSTICS
Active
Organization
PERSONAL GENOME DIAGNOSTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY T WILLIAMS (VICE PRESIDENT)
(336) 436-5402
Entity
Organization
Contact information
Practice address
3600 BOSTON ST STE 10, BALTIMORE, MD 21224-5729
(855) 743-9669
(443) 602-8833
Mailing address
PO BOX 2240, BURLINGTON, NC 27216-2240
(336) 222-7566
(443) 602-8833
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
21D2039282
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21D2039282
CLIA
—
Enumeration date
01/28/2013
Last updated
05/30/2024
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