John C Greenwald

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

055-002 Issued in GA

Legal business name

JOHN C GREENWALD

Doing business as

CK LABORATORIES

Practice address

51 Overview Dr
Blue Ridge, GA 30513-6611

Phone

(706) 946-5227

Fax

(706) 946-5228

NPI assigned

Jun 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. John Greenwald, MT

Title

Owner

Phone

(706) 946-5227

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• CK LABORATORIES Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496880000000",
    "number": "1063449437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 OVERVIEW DRIVE",
            "city": "BLUE RIDGE",
            "state": "GA",
            "postal_code": "305136648",
            "telephone_number": "706-946-5227",
            "fax_number": "706-946-5228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 OVERVIEW DR",
            "city": "BLUE RIDGE",
            "state": "GA",
            "postal_code": "305136611",
            "telephone_number": "706-946-5227",
            "fax_number": "706-946-5228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN C GREENWALD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-28",
        "last_updated": "2017-06-08",
        "status": "A",
        "authorized_official_last_name": "GREENWALD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-946-5227",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MT"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "GA",
            "license": "055-002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000968459A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "11D1001949",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LAB LICENSE",
            "identifier": "055-002",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CK LABORATORIES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mona Izadi, FNP-BC
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• Ronald Timothy Jabaley II, MD
• Samuel Christopher Jabaley, O.D.
• Esther Jean-Gratia, PSYD
• April Michelle Jones
• Ashley Megan Jones
• Jennifer Lee Jones, MD
• Susan K Kauffman, LMHC
• Kennestone Heart Physicians Group

• Clinical Medical Laboratory in Blue Ridge, GA
• Providers in Blue Ridge, GA by specialty
• Clinical Medical Laboratory in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.