Organization
VIDALIA LAB SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RILEY MCDONALD (PRESIDENT)
(912) 537-0622
Entity
Organization
Contact information
Practice address
801 MCNATT ST, VIDALIA, GA 30474-8808
(912) 537-0622
(912) 537-0641
Mailing address
801 MCNATT ST, VIDALIA, GA 30474-8808
(912) 537-0622
(912) 537-0641
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
06012R
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
604767895A
—
GA
01
—
P00317736
RAILROAD MEDICARE
GA
Enumeration date
07/11/2006
Last updated
04/08/2010
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