Organization
ADVANTAGE MEDICAL GROUP LABTORY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER YOUNG (CEO)
(803) 223-9193
Entity
Organization
Contact information
Practice address
9153 TWO NOTCH RD, COLUMBIA, SC 29223-5852
(803) 223-9193
Mailing address
9153 TWO NOTCH RD, COLUMBIA, SC 29223-5852
(803) 223-9193
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
3535
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3535
INDEPENDENT
SC
Enumeration date
05/05/2015
Last updated
05/05/2015
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