Provider Demographics
NPI:1083018295
Name:SALVUSLABS LLC
Entity Type:Organization
Organization Name:SALVUSLABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HYMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-738-1999
Mailing Address - Street 1:200 COBB PKWY N STE 124
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3538
Mailing Address - Country:US
Mailing Address - Phone:678-738-1999
Mailing Address - Fax:
Practice Address - Street 1:200 COBB PKWY N STE 124
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3538
Practice Address - Country:US
Practice Address - Phone:678-738-1999
Practice Address - Fax:678-236-0916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11D2084569291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11D2084569OtherCLIA