Organization
STAT TBI AND CONCUSSION DIAGNOSTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARNELL RANDALL (CEO)
(678) 372-3765
Entity
Organization
Contact information
Practice address
1100 LAKE ST STE LL56, OAK PARK, IL 60301-1034
(800) 767-8903
(888) 221-4798
Mailing address
1860 SANDY PLAINS RD, SUITE 200 PMB 2058, MARIETTA, GA 30066
(800) 767-8903
(888) 221-4798
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
—
—
Other
Enumeration date
01/05/2024
Last updated
01/08/2024
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