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NPI Code Detail

MEDICARE: LAB STAR MEDICAL LABORATORIES, LLC

MEDICARE: LAB STAR MEDICAL LABORATORIES, 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
1291U00000XClinical Medical Laboratory147-004GA

General Provider Information

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

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Directions to “LAB STAR MEDICAL LABORATORIES, LLC ” Practice Location

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