Organization
INDIVIDUALIZED TREATMENT TECHNOLOGIES LABORATORIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHNNY L. STODDARD (PRESIDENT AND CEO)
(256) 714-2105
Entity
Organization
Contact information
Practice address
2705 ARTIE ST SW, BUILDING 400 SUITE 25, HUNTSVILLE, AL 35805-4761
(256) 434-5160
(205) 930-0082
Mailing address
303 WILLIAMS AVE SW, SUITE 135, HUNTSVILLE, AL 35801-6012
(855) 436-6728
(256) 489-7134
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
L37174
AL
291U00000X
Clinical Medical Laboratory
Primary
L45100
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0544256
—
NJ
05
—
08976741
—
MS
05
—
103155
—
AZ
05
—
1043658966
—
IL
05
—
1043658966
—
MI
05
—
185597
—
AL
05
—
201369650A
—
IN
05
—
212246709
—
AR
05
—
3578338
—
TX
05
—
7100419330
—
KY
05
—
82987564
—
NM
05
—
L00494
—
SC
Enumeration date
06/13/2013
Last updated
04/05/2017
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