Organization
PHYSICIANS'S PROFESSIONAL LABORATORY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY D PORTER MD (VICE-PRESIDENT)
(404) 252-1968
Entity
Organization
Contact information
Practice address
5665 PEACHTREE DUNWOODY RD NE, ATLANTA, GA 30342-1701
(404) 252-1968
(404) 252-4609
Mailing address
PO BOX 720298, ATLANTA, GA 30358-2298
(404) 252-1968
(404) 252-4609
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
GA19749
GA
Other
Enumeration date
11/08/2006
Last updated
08/22/2020
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