Healthcare Provider Details

I. General information

NPI: 1508774589
Provider Name (Legal Business Name): MG LAB SERVICES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 GROVE PARK DR # 30248
LOCUST GROVE GA
30248-4573
US

IV. Provider business mailing address

480 GROVE PARK DR
LOCUST GROVE GA
30248-4573
US

V. Phone/Fax

Practice location:
  • Phone: 404-834-9934
  • Fax:
Mailing address:
  • Phone: 404-834-9934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARJORIEI PETIT
Title or Position: OWNER
Credential: OWNERSHIP
Phone: 404-834-9934