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ETHEREAL DIAGNOSTICS & SERVICES LLC
NPI 1629822259
Clinic/Center - Health Service in Valdosta, GA

Active since April 11, 2024
100 N PATTERSON ST STE A, VALDOSTA, GA 31601(877) 586-2971(866) 703-1440 Get Directions Write a Review

NPPES record last updated: April 11, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Ethereal Diagnostics & Services Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ETHEREAL DIAGNOSTICS & SERVICES LLC (NPI 1629822259) is a healthcare organization registered as a health service in Valdosta, Georgia and active in the NPI registry since April 2024. The organization lists Porsha Terell Robinson, Ceo, as its authorized official.

NPPES Registry Identity

NPI1629822259
Entity TypeOrganization
Primary Taxonomy261QH0100X
Legal Business NameETHEREAL DIAGNOSTICS & SERVICES LLC
Location Address100 N PATTERSON ST STE AValdosta, GA 31601-5570
Mailing Address1 Grand Park Ln Apt 3119Thomasville, GA 31757-4909 · (229) 579-6847
Phone(877) 586-2971
Fax(866) 703-1440
Organization SubpartNo
Authorized OfficialPorsha Terell RobinsonCeo · (877) 586-2971
Enumeration DateApril 11, 2024
NPPES CertifiedApril 11, 2024
✔ NPI 1629822259 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Health ServiceAmbulatory Health Care Facilities
Taxonomy Code261QH0100X
100 N PATTERSON ST STE A, Valdosta, GA 31601
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ethereal Diagnostics & Services LLC's NPI number?

The NPI number for Ethereal Diagnostics & Services LLC is 1629822259. It was assigned to this organization in the NPPES registry on April 11, 2024.

Where is Ethereal Diagnostics & Services LLC located?

Ethereal Diagnostics & Services LLC is located at 100 N Patterson St Ste A, Valdosta, GA 31601. The listed phone number is (877) 586-2971.

What is Ethereal Diagnostics & Services LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Health Service, with taxonomy code 261QH0100X.

When was this NPI record last updated?

The NPPES record for Ethereal Diagnostics & Services LLC was last updated on April 11, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.