Organization
CAROLINA LAB DIAGNOSTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA TILLEY HICKS NURSE PRACTITIONER (OWNER)
(704) 657-6367
Entity
Organization
Contact information
Practice address
632 SPRINGDALE RD, STATESVILLE, NC 28677-3432
(704) 657-6367
Mailing address
632 SPRINGDALE RD, STATESVILLE, NC 28677-3432
(704) 657-6367
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
03/08/2022
Last updated
03/08/2022
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