Provider Demographics
NPI:1568569796
Name:GENETIC ASSAYS, INC.
Entity Type:Organization
Organization Name:GENETIC ASSAYS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAMMARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-781-0709
Mailing Address - Street 1:4711 TROUSDALE DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37220-1321
Mailing Address - Country:US
Mailing Address - Phone:615-781-0709
Mailing Address - Fax:615-781-0766
Practice Address - Street 1:4711 TROUSDALE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1321
Practice Address - Country:US
Practice Address - Phone:615-781-0709
Practice Address - Fax:615-781-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003268291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0202182OtherBLUE CROSS BLUE SHIELD TN
AL690000007Medicaid
KY37000866Medicaid
3402805Medicare ID - Type Unspecified