Provider Demographics
NPI:1760494264
Name:LAB STAR MEDICAL LABORATORIES, LLC
Entity Type:Organization
Organization Name:LAB STAR MEDICAL LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-852-9432
Mailing Address - Street 1:PO BOX 1949
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-1998
Mailing Address - Country:US
Mailing Address - Phone:770-266-0613
Mailing Address - Fax:770-207-4991
Practice Address - Street 1:226 ALCOVY ST
Practice Address - Street 2:STE. A - 1
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2183
Practice Address - Country:US
Practice Address - Phone:770-266-0613
Practice Address - Fax:770-207-4991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA147-004291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory