Provider Demographics
NPI:1760894158
Name:AI BIOTECH, LLC
Entity Type:Organization
Organization Name:AI BIOTECH, LLC
Other - Org Name:AI BIOTECH- GA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOSTWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:804-915-3845
Mailing Address - Street 1:601 BIOTECH DRIVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-915-3845
Mailing Address - Fax:804-648-2641
Practice Address - Street 1:785 VIRGINIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1991
Practice Address - Country:US
Practice Address - Phone:804-648-3820
Practice Address - Fax:804-648-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory