Organization
PAPP CLINIC LABORATORY
Active
Parent organization
PAPP CLINIC, P.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
PAPP CLINIC, P.C.
Authorized official
KIMBERLY B. PERUSKI CPCS (CREDENTIALING COORDINATOR)
(770) 301-0231
Entity
Organization
Contact information
Practice address
15 CAVENDER ST, NEWNAN, GA 30263-1931
(770) 253-6616
Mailing address
15 CAVENDER ST, NEWNAN, GA 30263-1931
(770) 253-6616
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
038-005
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
038-005
DEPT OF HUMAN RESOURCES CLINICAL LAB LICENSE
GA
01
—
11D0257911
CLIA CERTIFICATION NUMBER
GA
Enumeration date
11/17/2008
Last updated
11/17/2008
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