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General NPI Number Information
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NPI Number | 1760494264
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Entity Type | Organization
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Legal Business Name | LAB STAR MEDICAL LABORATORIES, LLC
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 226 ALCOVY ST STE. A - 1
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City | MONROE
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State | GA
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Zip | 30655-2183
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Country | US
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Telephone | 770-266-0613
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Fax | 770-207-4991
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Provider Business Mailing Address
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Address Line | PO BOX 1949
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City | MONROE
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State | GA
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Zip | 30655-1998
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Country | US
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Telephone | 770-266-0613
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Fax | 770-207-4991
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Authorized Official
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Title or Position | OWNER
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Name | TIM DRAKE
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Credential |
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Telephone | 678-852-9432
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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 | 147-004
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License Number State | GA
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