Provider Demographics
NPI:1417283458
Name:ALL CLINICAL LABS
Entity Type:Organization
Organization Name:ALL CLINICAL LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRIER
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:770-957-3103
Mailing Address - Street 1:155 WESTRIDGE PKWY
Mailing Address - Street 2:102
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3049
Mailing Address - Country:US
Mailing Address - Phone:770-957-3103
Mailing Address - Fax:770-957-3141
Practice Address - Street 1:155 WESTRIDGE PARKWAY
Practice Address - Street 2:102
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253
Practice Address - Country:US
Practice Address - Phone:770-957-3103
Practice Address - Fax:770-957-3141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA26641291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory