Provider Demographics
NPI:1164210266
Name:CONCIERGE DIAGNOSTIC SERVICES LLC
Entity type:Organization
Organization Name:CONCIERGE DIAGNOSTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CORINTHIANS
Authorized Official - Middle Name:DEQUINDRAE
Authorized Official - Last Name:WASHINGTON, ED.D.
Authorized Official - Suffix:
Authorized Official - Credentials:DO, CDCA, EDD
Authorized Official - Phone:470-241-6604
Mailing Address - Street 1:1220 2ND AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1111
Mailing Address - Country:US
Mailing Address - Phone:470-241-6604
Mailing Address - Fax:706-940-4415
Practice Address - Street 1:1220 2ND AVE STE 6
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1114
Practice Address - Country:US
Practice Address - Phone:470-241-6604
Practice Address - Fax:706-940-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-28
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical PathologyGroup - Multi-Specialty