Provider Demographics
NPI:1164187472
Name:SERENDIPITY CARE LAB SERVICES LLC
Entity Type:Organization
Organization Name:SERENDIPITY CARE LAB SERVICES LLC
Other - Org Name:SERENDIPITY CARE LAB SERVICES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-964-4099
Mailing Address - Street 1:5823 WEBB FOREST CT
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-9061
Mailing Address - Country:US
Mailing Address - Phone:404-964-4099
Mailing Address - Fax:
Practice Address - Street 1:5823 WEBB FOREST CT
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-9061
Practice Address - Country:US
Practice Address - Phone:404-478-6409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No291U00000XLaboratoriesClinical Medical Laboratory