Provider Demographics
NPI:1144568437
Name:AWSG LLC
Entity Type:Organization
Organization Name:AWSG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-904-5999
Mailing Address - Street 1:2678 BUFORD HWY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3240
Mailing Address - Country:US
Mailing Address - Phone:678-904-5999
Mailing Address - Fax:678-298-6519
Practice Address - Street 1:2678 BUFORD HWY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3240
Practice Address - Country:US
Practice Address - Phone:678-904-5999
Practice Address - Fax:678-298-6519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA28500291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory