Provider Demographics
NPI:1255946869
Name:EMERGENT TESTING LAB LLC
Entity type:Organization
Organization Name:EMERGENT TESTING LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-819-6417
Mailing Address - Street 1:13 CORPORATE BLVD NE STE 250
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1901
Mailing Address - Country:US
Mailing Address - Phone:470-467-0124
Mailing Address - Fax:
Practice Address - Street 1:13 CORPORATE BLVD NE STE 250
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-1901
Practice Address - Country:US
Practice Address - Phone:678-941-4278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic PathologyGroup - Single Specialty