NPI 1770230492

Fourth Wall Testing LLC

Organisation Clinical Medical Laboratory Johns Creek, GA

Practice location

Address: 11705 Jones Bridge Rd STE B101, Johns Creek, GA 30005-5080
Phone: (678) 580-5908
Mailing address: 712 S Ocean Shore Blvd # 217, Flagler Beach, FL 32136-3602

Authorised official

Name: Lisa Wilson
Title: President
Phone: (352) 630-0886

Registered specialties

Clinical Medical Laboratory Primary

Laboratories Taxonomy 291U00000X

Other Clinical Medical Laboratory providers in Georgia →

Registry record

NPI: 1770230492
Entity type: Organization
NPI issued: 2 Mar 2022
Record last updated: 12 Oct 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.