Provider Demographics
NPI:1295806552
Name:CSI GENETICS, LLC
Entity type:Organization
Organization Name:CSI GENETICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:H
Authorized Official - Last Name:GHAFARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-205-4346
Mailing Address - Street 1:11525 PARK WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4482
Mailing Address - Country:US
Mailing Address - Phone:678-205-4346
Mailing Address - Fax:678-205-4347
Practice Address - Street 1:11525 PARK WOODS CIR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4482
Practice Address - Country:US
Practice Address - Phone:678-205-4346
Practice Address - Fax:678-205-4347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-327291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1458431Medicaid
WI36203900Medicaid
LA1458431Medicaid