MEDICARE: TRANS ALLIANCE LAB

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	302R00000X	Health Maintenance Organization	PHRE008987	GA

General Provider Information

NPI Number	:	1992819072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANS ALLIANCE LAB

Provider Business Mailing Address
First Line	:	PO BOX 767757
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-7757
Country	:	US
Telephone Number	:	404-699-9000
Fax Number	:	404-699-9111

Provider Business Practice Location Address
First Line	:	3050 MARTIN LUTHER KING JR DR SW STE H
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-1500
Country	:	US
Telephone Number	:	404-699-9000
Fax Number	:	404-699-9111

Authorized Official
Title or Position	:	PHARMACIST
Name	:	CHINWE BIBI NWABUDE
Credential	:
Telephone Number	:	404-699-9000

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	08/22/2020

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Directions to “TRANS ALLIANCE LAB ” Practice Location

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