Provider Demographics
NPI:1174507628
Name:LABORATORY CORPORATION OF AMERICA
Entity Type:Organization
Organization Name:LABORATORY CORPORATION OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO EVP TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-222-7566
Mailing Address - Street 1:PO BOX 2240
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-2240
Mailing Address - Country:US
Mailing Address - Phone:800-222-7566
Mailing Address - Fax:336-436-1048
Practice Address - Street 1:410 CONNELL RD
Practice Address - Street 2:SUITE C
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-0000
Practice Address - Country:US
Practice Address - Phone:229-671-1207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00971033AMedicaid
GA69WBDLHMedicare PIN