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1073802153 NPI number — POLARIS ALLERGY LABS, INC.

NPI Number: 1073802153
Health Care Provider/Practitioner: POLARIS ALLERGY LABS, INC.

Information about “1073802153” NPI (POLARIS ALLERGY LABS, INC.) exists in 1073802153 in HTML format HTML  |  1073802153 in plain Text format TXT  |  1073802153 in PDF (Portable Document Format) PDF  |  1073802153 in an XML format XML  formats.

NPI Number : 1073802153 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073802153",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "POLARIS ALLERGY LABS, INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3316 S COBB DR SE STE A",
    "SecondLineMailingAddress": "SUITE 215",
    "MailingAddressCityName": "SMYRNA",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30080-4107",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "404-419-6311",
    "MailingAddressFaxNumber": "404-419-6311",
    "FirstLinePracticeLocationAddress": "3485 N DESERT DR",
    "SecondLinePracticeLocationAddress": "BUILDING 2, SUITE 206A",
    "PracticeLocationAddressCityName": "EAST POINT",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30344-5724",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "404-419-6311",
    "PracticeLocationAddressFaxNumber": "404-419-6311",
    "EnumerationDate": "03/29/2011",
    "LastUpdateDate": "08/08/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GARTH",
    "AuthorizedOfficialFirstName": "R. JACKSON",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT/CEO",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MBA, DBA",
    "AuthorizedOfficialTelephoneNumber": "404-419-6311",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "291U00000X",
        "TaxonomyName": "Clinical Medical Laboratory",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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