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General NPI Number Information
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NPI Number | 1013784503
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Entity Type | Organization
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Legal Business Name | ASTRAEUS LAB LLC
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Dates
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Enumeration Date | 12/05/2023
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 1240 JOHNSON FERRY PL STE 102
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City | MARIETTA
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State | GA
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Zip | 30068-2032
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Country | US
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Telephone | 678-615-8151
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Fax |
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Provider Business Mailing Address
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Address Line | 1240 JOHNSON FERRY PL STE 102
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City | MARIETTA
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State | GA
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Zip | 30068-2032
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RAYMOND GODWIN
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Credential |
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Telephone | 678-687-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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