Organization · NPI-2

4 Life Lab

Clinic/Center · Charlotte, NC

NPI number1821501800
StatusActive
Last updated in NPPESJun 20, 2018

Details

NPI
1821501800
Entity type
Organization (NPI-2)
Legal business name
4 Life Lab
Organization subpart
No
Enumeration date
Nov 13, 2017
Last updated
Jun 20, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center–NCYes

Practice location

11709 Fruehauf Dr Ste 103
Charlotte, NC 28273-7285

Phone 318-278-1319

Mailing address

201 W Olive Ave
Ruston, LA 71270-6356

Authorized official

Markuetric D Stringfellow
Owner
3182781319

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Clinic/Center providers in Charlotte, NC