Organization
ETHEREAL DIAGNOSTICS & SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PORSHA TERELL ROBINSON RN (CEO)
(877) 586-2971
Entity
Organization
Contact information
Practice address
100 N PATTERSON ST STE A, VALDOSTA, GA 31601-5570
(877) 586-2971
(866) 703-1440
Mailing address
1 GRAND PARK LN APT 3119, THOMASVILLE, GA 31757-4909
(229) 579-6847
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
04/11/2024
Last updated
04/11/2024
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