Provider Demographics
NPI:1891130639
Name:DUNWOODY LABS INC
Entity Type:Organization
Organization Name:DUNWOODY LABS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-736-6374
Mailing Address - Street 1:9 DUNWOODY PARK
Mailing Address - Street 2:SUITE 121
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7407
Mailing Address - Country:US
Mailing Address - Phone:678-736-6374
Mailing Address - Fax:404-393-5564
Practice Address - Street 1:9 DUNWOODY PARK
Practice Address - Street 2:SUITE 121
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-7407
Practice Address - Country:US
Practice Address - Phone:678-736-6374
Practice Address - Fax:404-393-5564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018579291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory