MEDICARE: ENVISION HEALTHCARE RESOURCES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	067-081	GA

General Provider Information

NPI Number	:	1285169359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENVISION HEALTHCARE RESOURCES, LLC

Provider Business Mailing Address
First Line	:	629 AIRPORT RD STE J
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-4474
Country	:	US
Telephone Number	:	678-251-8180
Fax Number	:	770-545-8840

Provider Business Practice Location Address
First Line	:	629 AIRPORT RD
Second Line	:	SUITE C
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-4474
Country	:	US
Telephone Number	:	770-545-8877
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MRS. MIKELLE COLEBY
Credential	:	MT(ASCP)
Telephone Number	:	678-251-8180

Provider Enumeration Date	:	04/26/2017
Last Update Date	:	04/30/2024

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