Daily Lab Sources

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

DAILY LAB SOURCES

Practice address

2838 S Elm Eugene St
Suite 205
Greensboro, NC 27406-4410

Phone

(704) 953-9432

NPI assigned

Jan 3, 2017

Last updated

Jan 3, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Tyrell Timothy Fulwood

Title

Owner

Phone

(704) 953-9432

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1483401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483401600000",
    "number": "1114462934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2838 S ELM EUGENE ST",
            "address_2": "SUITE 205",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274064410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2838 S ELM EUGENE ST",
            "address_2": "SUITE 205",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274064410",
            "telephone_number": "704-953-9432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAILY LAB SOURCES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-03",
        "last_updated": "2017-01-03",
        "status": "A",
        "authorized_official_last_name": "FULWOOD",
        "authorized_official_first_name": "TYRELL",
        "authorized_official_middle_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-953-9432",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA CERTIFICATE",
            "identifier": "34D2120415",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rosalyn Annamarie D'Mello, DO
• Amanda D'Ostroph
• Jennifer Dadzie, PHARM D
• Kierra Dages, DMD
• Stephen Michael Dahlstedt, MD
• Vinay C. Dakoriya, RPH
• Barbara Caviness Dale
• Christine Dale
• Taylor Mackenzie Dale, PA-C
• Shannon Dalkey, M.A. CCC-SLP

• Clinical Medical Laboratory in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Clinical Medical Laboratory in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 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.