Provider Demographics
NPI:1568249050
Name:MCCOY LAB SERVICES LLC
Entity Type:Organization
Organization Name:MCCOY LAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YASHAIKA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-941-7323
Mailing Address - Street 1:244 SOPHIE CIR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-4464
Mailing Address - Country:US
Mailing Address - Phone:678-941-7323
Mailing Address - Fax:
Practice Address - Street 1:244 SOPHIE CIR
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-4464
Practice Address - Country:US
Practice Address - Phone:678-941-7323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine