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General NPI Number Information
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NPI Number | 1215318076
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Entity Type | Organization
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Legal Business Name | SOUTHEAST LAB SERVICES, LLC
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 11/17/2017
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Provider Practice Location Address
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Address Line | 270 CARPENTER DRIVE SUITE 680
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City | SANDY SPRINGS
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State | GA
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Zip | 30328
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Country | US
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Telephone | 404-381-1564
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Fax |
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Provider Business Mailing Address
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Address Line | 270 CARPENTER DR SUITE 680
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-4931
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Country | US
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Telephone | 404-381-1564
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Fax |
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Authorized Official
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Title or Position | LAB DIRECTOR
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Name | DR. JOSEPH HACKLE
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Credential | M.D.
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Telephone | 404-381-1567
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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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