Organization
PORTABLE MEDICAL DIAGNOSTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS BROWN (MANAGING MEMBER)
(601) 987-9729
Entity
Organization
Contact information
Practice address
9047 HOME AVE, IRVINGTON, AL 36544-2855
(251) 272-1080
(251) 272-1080
Mailing address
1855 LAKELAND DR, STE G10, JACKSON, MS 39216-4913
(601) 987-9729
(601) 987-0093
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9074
STATE BOARD OF HEALTH IPL LICENSE
AL
Enumeration date
12/26/2012
Last updated
07/21/2014
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