Provider Demographics
NPI:1801449327
Name:CERTIVIA LABORATORIES LLC
Entity type:Organization
Organization Name:CERTIVIA LABORATORIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:HAFEEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-617-8550
Mailing Address - Street 1:PO BOX 920588
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30010-0588
Mailing Address - Country:US
Mailing Address - Phone:770-696-2522
Mailing Address - Fax:844-941-1992
Practice Address - Street 1:2166 W PARK CT STE F
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3546
Practice Address - Country:US
Practice Address - Phone:770-696-2522
Practice Address - Fax:844-941-1992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory