Organization
JOHN C GREENWALD
Active
Other names
CK LABORATORIES
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN GREENWALD MT (OWNER)
(706) 946-5227
Entity
Organization
Contact information
Practice address
51 OVERVIEW DR, BLUE RIDGE, GA 30513-6611
(706) 946-5227
(706) 946-5228
Mailing address
51 OVERVIEW DRIVE, BLUE RIDGE, GA 30513-6648
(706) 946-5227
(706) 946-5228
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
055-002
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000968459A
—
GA
01
—
055-002
STATE LAB LICENSE
GA
01
—
11D1001949
CLIA
GA
Enumeration date
06/28/2006
Last updated
06/08/2017
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