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General NPI Number Information
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NPI Number | 1982101929
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Entity Type | Organization
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Legal Business Name | GOLGI LABS, LLC
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 333 ALCOVY ST STE 4
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City | MONROE
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State | GA
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Zip | 30655-2180
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Country | US
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Telephone | 678-294-1826
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Fax | 678-294-1826
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Provider Business Mailing Address
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Address Line | 333 ALCOVY ST STE 4
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City | MONROE
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State | GA
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Zip | 30655-2180
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Country | US
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Telephone | 678-294-1826
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Fax | 678-294-1826
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Authorized Official
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Title or Position | OFFICER
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Name | DHANUNJAYA R GADDAM
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Credential |
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Telephone | 678-294-1826
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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 | 11D2146695
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License Number State | GA
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