Preferred Labs of Vidalia LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PREFERRED LABS OF VIDALIA LLC

Practice address

414 Lugenia Dr
Vidalia, GA 30474-7210

Phone

(912) 386-7117

NPI assigned

Nov 11, 2021

Organization subpart

No

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

Authorized official

Name

Amjad Khan Mohammed

Title

Authorized Official

Phone

(912) 386-7117

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1636588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733356800000",
    "number": "1114683489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 LUGENIA DR",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304747210",
            "telephone_number": "912-386-7117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 LUGENIA DR",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304747210",
            "telephone_number": "912-386-7117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREFERRED LABS OF VIDALIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-11",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-05",
        "status": "A",
        "authorized_official_last_name": "MOHAMMED",
        "authorized_official_first_name": "AMJAD KHAN",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "912-386-7117"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Macey Alexis Phillips
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• Clinical Medical Laboratory in Vidalia, GA
• Providers in Vidalia, 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 Dec 5, 2024; 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.