Provider Demographics
NPI:1013940162
Name:TRANS ALLIANCE LAB INC
Entity Type:Organization
Organization Name:TRANS ALLIANCE LAB INC
Other - Org Name:TRANS ALLIANCE MED AND DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CHINWE
Authorized Official - Middle Name:BIBI
Authorized Official - Last Name:NWABUDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-992-9940
Mailing Address - Street 1:2650 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE 540
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2650 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 540
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022
Practice Address - Country:US
Practice Address - Phone:770-992-9940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA542140976A251E00000X
GA5784610003332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA697630993AMedicaid
GA542140976AMedicaid
5784610003Medicare NSC