Organization
ALLEGIANT SOLUTIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TREVOR SHAW (MANAGER)
(229) 460-8671
Entity
Organization
Contact information
Practice address
5101 NORTHWIND BLVD STE B, VALDOSTA, GA 31605-7774
(229) 262-7242
(229) 262-7248
Mailing address
5101 NORTHWIND BLVD STE B, VALDOSTA, GA 31605-7774
(229) 262-7242
(229) 262-7248
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003245188A
—
GA
Enumeration date
10/05/2020
Last updated
11/04/2021
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