Provider Demographics
NPI:1184084501
Name:BIOTREK LABORATORIES
Entity type:Organization
Organization Name:BIOTREK LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MECHWART
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:404-831-9788
Mailing Address - Street 1:821 DAWSONVILLE HWY
Mailing Address - Street 2:BLDG. 250, #101
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2636
Mailing Address - Country:US
Mailing Address - Phone:404-831-9788
Mailing Address - Fax:
Practice Address - Street 1:446 GREEN ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3312
Practice Address - Country:US
Practice Address - Phone:404-831-9788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11D2090741291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory