Provider Demographics
NPI:1427041888
Name:METAMETRIX INC
Entity Type:Organization
Organization Name:METAMETRIX INC
Other - Org Name:METAMETRIX CLINICAL LABORATORY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-446-5483
Mailing Address - Street 1:3425 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096
Mailing Address - Country:US
Mailing Address - Phone:770-446-5483
Mailing Address - Fax:770-441-2237
Practice Address - Street 1:3425 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:770-446-5483
Practice Address - Fax:770-441-2237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METAMETRIX INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-31
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067007291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAX12948Medicare UPIN