Provider Demographics
NPI:1184345902
Name:TRAVEL LABS, LLC
Entity type:Organization
Organization Name:TRAVEL LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEMPLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:678-558-5340
Mailing Address - Street 1:6600 SUGARLOAF PKWY STE 400-340
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4344
Mailing Address - Country:US
Mailing Address - Phone:678-558-5340
Mailing Address - Fax:
Practice Address - Street 1:6600 SUGARLOAF PKWY STE 400-340
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4344
Practice Address - Country:US
Practice Address - Phone:678-558-5340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service