Provider Demographics
NPI:1396419933
Name:ATLANTIC LABS LLC
Entity type:Organization
Organization Name:ATLANTIC LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-222-0621
Mailing Address - Street 1:PO BOX 143311
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75014-3311
Mailing Address - Country:US
Mailing Address - Phone:325-222-0621
Mailing Address - Fax:346-521-3028
Practice Address - Street 1:1329 W WALNUT HILL LN STE 116
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3270
Practice Address - Country:US
Practice Address - Phone:325-222-0621
Practice Address - Fax:346-521-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory