Provider Demographics
NPI:1841203429
Name:METAMARK LABORATORIES, INC.
Entity Type:Organization
Organization Name:METAMARK LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:SATHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTHANDARAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-420-8243
Mailing Address - Street 1:985 BROAD ST.
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-1286
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:985 BROAD ST.
Practice Address - Street 2:SUITE A
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1286
Practice Address - Country:US
Practice Address - Phone:877-743-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2017-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121-058291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADE3909OtherRR MEDICARE
GAGRP7569Medicare ID - Type Unspecified
GADE3909OtherRR MEDICARE