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NPI Code Detail

MEDICARE: INFINITE LABORATORIES GA LLC

MEDICARE: INFINITE LABORATORIES GA 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 Laboratory

General Provider Information

NPI Number : 1932617917
Entity Type Code : Organization
Provider Name (Legal Business Name) : INFINITE LABORATORIES GA LLC
Provider Business Mailing Address
First Line : 6006 MANCHESTER CIR
Second Line :
City : ROSWELL
State : GA
Zip : 30075-8288
Country : US
Telephone Number : 615-918-8946
Fax Number :
Provider Business Practice Location Address
First Line : 4300 PLEASANT HILL RD STE A
Second Line :
City : DULUTH
State : GA
Zip : 30096-6379
Country : US
Telephone Number : 615-243-8004
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. ANTOINETTE LOUISE GASTON
Credential : PH.D.
Telephone Number : 615-243-8004
Provider Enumeration Date : 01/12/2018
Last Update Date : 01/12/2018

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Directions to “INFINITE LABORATORIES GA LLC ” Practice Location

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