Provider Demographics
NPI:1346571544
Name:ALL CLINICAL LABS PHASE 1 INC
Entity Type:Organization
Organization Name:ALL CLINICAL LABS PHASE 1 INC
Other - Org Name:ALL CLINICAL LABS PHASE 1 INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHLEB TECHNOLOGISTS
Authorized Official - Phone:678-743-5503
Mailing Address - Street 1:87 HIGHWAY 138 W
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4293
Mailing Address - Country:US
Mailing Address - Phone:678-743-5503
Mailing Address - Fax:678-743-5503
Practice Address - Street 1:87 HIGHWAY 138 W
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4293
Practice Address - Country:US
Practice Address - Phone:678-743-5503
Practice Address - Fax:678-743-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2010004291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory