Provider Demographics
NPI:1144621616
Name:GBT LAB INC
Entity Type:Organization
Organization Name:GBT LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:COKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-644-7753
Mailing Address - Street 1:3101 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2790
Mailing Address - Country:US
Mailing Address - Phone:813-644-7753
Mailing Address - Fax:888-482-2405
Practice Address - Street 1:3101 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 203
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2790
Practice Address - Country:US
Practice Address - Phone:813-644-7753
Practice Address - Fax:888-482-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2080343291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory