Provider Demographics
NPI:1093069270
Name:CONFIRMATRIX LABORATORY INC
Entity Type:Organization
Organization Name:CONFIRMATRIX LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-407-9818
Mailing Address - Street 1:1770 CEDARS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-6702
Mailing Address - Country:US
Mailing Address - Phone:678-407-9818
Mailing Address - Fax:678-407-9819
Practice Address - Street 1:1770 CEDARS RD STE 200
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-6702
Practice Address - Country:US
Practice Address - Phone:678-407-9818
Practice Address - Fax:678-407-9819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12030R291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129831AMedicaid
GA11D2047828OtherCLIA
GA003129831AMedicaid