Provider Demographics
NPI:1083988216
Name:NEXUS LABORATORIES, INC.
Entity Type:Organization
Organization Name:NEXUS LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALPHONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:404-376-8325
Mailing Address - Street 1:1670 SCOTT BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1424
Mailing Address - Country:US
Mailing Address - Phone:404-296-8100
Mailing Address - Fax:404-294-8467
Practice Address - Street 1:1670 SCOTT BLVD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-376-8325
Practice Address - Fax:404-294-8467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA97048291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory