Provider Demographics
NPI:1053076844
Name:EXPRESS LAB SERVICES, LLC
Entity Type:Organization
Organization Name:EXPRESS LAB SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREKA
Authorized Official - Middle Name:
Authorized Official - Last Name:THRASH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:706-358-1534
Mailing Address - Street 1:6361 TALOKAS LN STE C140-208
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-5642
Mailing Address - Country:US
Mailing Address - Phone:706-786-2636
Mailing Address - Fax:706-204-3805
Practice Address - Street 1:6361 TALOKAS LN STE C140-208
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-5642
Practice Address - Country:US
Practice Address - Phone:706-786-2636
Practice Address - Fax:706-204-3805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service