Provider Demographics
NPI:1407736002
Name:MICROSURE LLC
Entity type:Organization
Organization Name:MICROSURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FORTENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-393-0340
Mailing Address - Street 1:7851 HICKORY FLAT HWY STE 204
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-2352
Mailing Address - Country:US
Mailing Address - Phone:256-393-0340
Mailing Address - Fax:
Practice Address - Street 1:7851 HICKORY FLAT HWY STE 204
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-2352
Practice Address - Country:US
Practice Address - Phone:256-393-0340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory ManagementGroup - Single Specialty