Provider Demographics
NPI:1639500648
Name:SICKLE CELL FOUNDATION OF GEORGIA, INC.
Entity Type:Organization
Organization Name:SICKLE CELL FOUNDATION OF GEORGIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-755-2291
Mailing Address - Street 1:2391 BENJAMIN E MAYS DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-3251
Mailing Address - Country:US
Mailing Address - Phone:404-755-2291
Mailing Address - Fax:404-755-5377
Practice Address - Street 1:2391 BENJAMIN E MAYS DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-3251
Practice Address - Country:US
Practice Address - Phone:404-755-2291
Practice Address - Fax:404-755-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALAB000323291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory