Provider Demographics
NPI:1225547276
Name:ADAM SCIENTIFIC LABS
Entity Type:Organization
Organization Name:ADAM SCIENTIFIC LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-431-0482
Mailing Address - Street 1:101 MARIETTA ST NW STE 1450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2759
Mailing Address - Country:US
Mailing Address - Phone:404-431-0482
Mailing Address - Fax:678-707-5819
Practice Address - Street 1:2225 CENTENNIAL DR STE 103
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-5760
Practice Address - Country:US
Practice Address - Phone:404-431-0482
Practice Address - Fax:678-702-5819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069-023291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory