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General NPI Number Information
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NPI Number | 1922977263
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Entity Type | Organization
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Legal Business Name | SUMMIT CLINICAL LABORTARY INC
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Dates
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Enumeration Date | 11/04/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 1565 WOODINGTON CIR STE 103
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2986
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Country | US
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Telephone | 678-825-6836
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Fax | 678-682-7664
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Provider Business Mailing Address
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Address Line | 1565 WOODINGTON CIR STE 103
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2986
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Country | US
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Telephone | 678-825-6836
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Fax | 678-682-7664
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAHITH DEVATHI
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Credential |
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Telephone | 217-494-5752
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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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