Provider Demographics
NPI:1235621087
Name:GEORGIA LABORATORY MANAGEMENT LLC
Entity Type:Organization
Organization Name:GEORGIA LABORATORY MANAGEMENT LLC
Other - Org Name:INFINITE LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:JOOMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-971-5256
Mailing Address - Street 1:3885 CRESTWOOD PKWY NW STE 550
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-7169
Mailing Address - Country:US
Mailing Address - Phone:678-971-5256
Mailing Address - Fax:678-905-1495
Practice Address - Street 1:3885 CRESTWOOD PKWY NW STE 550
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-7169
Practice Address - Country:US
Practice Address - Phone:678-971-5256
Practice Address - Fax:678-905-1495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11D2142105291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory