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General NPI Number Information
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NPI Number | 1235621087
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Entity Type | Organization
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Legal Business Name | GEORGIA LABORATORY MANAGEMENT LLC
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 5555 OAKBROOK PKWY STE 140
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City | NORCROSS
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State | GA
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Zip | 30093-6209
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Country | US
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Telephone | 678-971-5256
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Fax | 678-905-1495
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Provider Business Mailing Address
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Address Line | 5555 OAKBROOK PKWY STE 140
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City | NORCROSS
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State | GA
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Zip | 30093-6209
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Country | US
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Telephone | 678-971-5256
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Fax | 678-905-1495
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Authorized Official
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Title or Position | CEO
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Name | NICK JOOMA
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Credential |
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Telephone | 678-971-5256
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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 | 11D2142105
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License Number State | GA
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