Provider Demographics
NPI:1679590236
Name:AMERICAN CLINICAL LABORATORY,INC
Entity Type:Organization
Organization Name:AMERICAN CLINICAL LABORATORY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-717-8801
Mailing Address - Street 1:5500B LILBURN STONE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-2841
Mailing Address - Country:US
Mailing Address - Phone:770-717-8801
Mailing Address - Fax:770-717-8808
Practice Address - Street 1:5500B LILBURN STONE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-2841
Practice Address - Country:US
Practice Address - Phone:770-717-8801
Practice Address - Fax:770-717-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-126291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory