Provider Demographics
NPI:1053609271
Name:MEDICAL DIAGNOSTIC SOLUTIONS LLC
Entity type:Organization
Organization Name:MEDICAL DIAGNOSTIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-314-7843
Mailing Address - Street 1:1270 CAROLINE ST NE
Mailing Address - Street 2:SUITE D120-435
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-2758
Mailing Address - Country:US
Mailing Address - Phone:404-314-7843
Mailing Address - Fax:404-344-7733
Practice Address - Street 1:1270 CAROLINE ST NE
Practice Address - Street 2:SUITE D120-435
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-2758
Practice Address - Country:US
Practice Address - Phone:404-314-7843
Practice Address - Fax:404-344-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory