Provider Demographics
NPI:1275766370
Name:ELAB SOLUTIONS CORPORATION
Entity Type:Organization
Organization Name:ELAB SOLUTIONS CORPORATION
Other - Org Name:ELAB CONSULTING SERVICES, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:EUTONNE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:770-988-9173
Mailing Address - Street 1:5009 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2223
Mailing Address - Country:US
Mailing Address - Phone:770-988-9173
Mailing Address - Fax:770-988-9943
Practice Address - Street 1:5009 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342-2223
Practice Address - Country:US
Practice Address - Phone:770-988-9173
Practice Address - Fax:770-988-9943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003124056AMedicaid
GA202G692740Medicare PIN