Organization
MYGENETX LABORATORY LLC
Active
Other names
Lifetime Sciences
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TROY MIZELL (PRESIDENT)
(615) 550-5880
Entity
Organization
Contact information
Practice address
4037 RURAL PLAINS CIR STE 150, FRANKLIN, TN 37064-1868
(615) 550-5880
(615) 550-5889
Mailing address
4037 RURAL PLAINS CIR STE 150, FRANKLIN, TN 37064-1868
(615) 550-5880
(615) 550-5889
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44D2031868
CLIA ID NUMBER
—
01
—
45D2059216
CLIA
TX
Enumeration date
03/16/2012
Last updated
11/29/2023
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