Provider Demographics
NPI:1033977681
Name:GENESIS DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:GENESIS DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HELMIE
Authorized Official - Middle Name:DEMEL
Authorized Official - Last Name:TEKETAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-223-9727
Mailing Address - Street 1:5014 STONE MOUNTAIN HWY STE H
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-7710
Mailing Address - Country:US
Mailing Address - Phone:678-899-0161
Mailing Address - Fax:
Practice Address - Street 1:5014 STONE MOUNTAIN HWY STE H
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-7710
Practice Address - Country:US
Practice Address - Phone:678-899-0161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory