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General NPI Number Information
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NPI Number | 1679590236
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Entity Type | Organization
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Legal Business Name | AMERICAN CLINICAL LABORATORY,INC
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 5500B LILBURN STONE MOUNTAIN RD
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-2841
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Country | US
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Telephone | 770-717-8801
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Fax | 770-717-8808
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Provider Business Mailing Address
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Address Line | 5500B LILBURN STONE MOUNTAIN RD
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-2841
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Country | US
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Telephone | 770-717-8801
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Fax | 770-717-8808
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. ARUN K KHANNA
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Credential | PHD
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Telephone | 770-717-8801
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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 | 044-126
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License Number State | GA
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