Provider Demographics
NPI:1871024273
Name:360 LABORATORIES, LLC
Entity Type:Organization
Organization Name:360 LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-617-6060
Mailing Address - Street 1:1180 BEAVER RUIN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-6801
Mailing Address - Country:US
Mailing Address - Phone:678-235-4212
Mailing Address - Fax:678-399-3659
Practice Address - Street 1:1180 BEAVER RUIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-6801
Practice Address - Country:US
Practice Address - Phone:678-235-4212
Practice Address - Fax:678-399-3659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-078291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory