Provider Demographics
NPI:1073802153
Name:POLARIS ALLERGY LABS, INC.
Entity Type:Organization
Organization Name:POLARIS ALLERGY LABS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:R. JACKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:GARTH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, DBA
Authorized Official - Phone:404-419-6311
Mailing Address - Street 1:3316 S COBB DR SE STE A
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4107
Mailing Address - Country:US
Mailing Address - Phone:404-419-6311
Mailing Address - Fax:404-419-6311
Practice Address - Street 1:3485 N DESERT DR
Practice Address - Street 2:BUILDING 2, SUITE 206A
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5724
Practice Address - Country:US
Practice Address - Phone:404-419-6311
Practice Address - Fax:404-419-6311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory