Healthcare Provider Details

I. General information

NPI: 1932617917
Provider Name (Legal Business Name): INFINITE LABORATORIES GA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 PLEASANT HILL RD STE A
DULUTH GA
30096-6379
US

IV. Provider business mailing address

6006 MANCHESTER CIR
ROSWELL GA
30075-8288
US

V. Phone/Fax

Practice location:
  • Phone: 615-243-8004
  • Fax:
Mailing address:
  • Phone: 615-918-8946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTOINETTE LOUISE GASTON
Title or Position: CEO
Credential: PH.D.
Phone: 615-243-8004