Provider Demographics
NPI:1467092700
Name:QITEK LABS LLC
Entity Type:Organization
Organization Name:QITEK LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSK
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:888-857-4835
Mailing Address - Street 1:4375 RIVER GREEN PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8319
Mailing Address - Country:US
Mailing Address - Phone:888-857-4835
Mailing Address - Fax:470-645-9256
Practice Address - Street 1:4375 RIVER GREEN PKWY STE 200
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8319
Practice Address - Country:US
Practice Address - Phone:888-857-4835
Practice Address - Fax:470-645-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003231686AMedicaid