Provider Demographics
NPI:1891889747
Name:RELIANCE MEDICAL LABORATORIES, INC.
Entity Type:Organization
Organization Name:RELIANCE MEDICAL LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:770-723-0722
Mailing Address - Street 1:2200 NORTHLAKE PKWY
Mailing Address - Street 2:SUITE 236
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4022
Mailing Address - Country:US
Mailing Address - Phone:770-723-0722
Mailing Address - Fax:770-723-0578
Practice Address - Street 1:2200 NORTHLAKE PKWY
Practice Address - Street 2:SUITE 236
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4022
Practice Address - Country:US
Practice Address - Phone:770-723-0722
Practice Address - Fax:770-723-0578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-151291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory