Provider Demographics
NPI:1710409545
Name:ELITE MEDICAL LABORATORIES INC
Entity Type:Organization
Organization Name:ELITE MEDICAL LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALID
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-451-7241
Mailing Address - Street 1:1130 HURRICANE SHOALS RD NE STE 1300
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4871
Mailing Address - Country:US
Mailing Address - Phone:404-451-7241
Mailing Address - Fax:
Practice Address - Street 1:1130 HURRICANE SHOALS RD NE STE 1300
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-4871
Practice Address - Country:US
Practice Address - Phone:706-400-4295
Practice Address - Fax:770-545-8523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory