Organization
PROVISTA DIAGNOSTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
URIEL KUSIATIN (CEO)
(470) 758-2777
Entity
Organization
Contact information
Practice address
2001 WESTSIDE PKWY STE 240, ALPHARETTA, GA 30004-7408
(470) 758-2777
Mailing address
2001 WESTSIDE PKWY STE 240, ALPHARETTA, GA 30004-7408
(470) 758-2777
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
08/04/2020
Last updated
08/04/2020
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