Provider Demographics
NPI:1336761923
Name:MAJL DIAGNOSTIC LABORATORIES LLC
Entity Type:Organization
Organization Name:MAJL DIAGNOSTIC LABORATORIES LLC
Other - Org Name:MAJL DIAGNOSTIC LABORATORIES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:LAVON
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-272-5008
Mailing Address - Street 1:8920 FIRESTONE CIR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-6627
Mailing Address - Country:US
Mailing Address - Phone:877-272-5008
Mailing Address - Fax:
Practice Address - Street 1:6290 MCDONOUGH DR STE D
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1291
Practice Address - Country:US
Practice Address - Phone:770-870-9481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory