Provider Demographics
NPI:1912481508
Name:NEXT GENOMIX LABORATORIES, INC
Entity Type:Organization
Organization Name:NEXT GENOMIX LABORATORIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-988-6951
Mailing Address - Street 1:6270 MCDONOUGH DR STE G
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1242
Mailing Address - Country:US
Mailing Address - Phone:770-988-6951
Mailing Address - Fax:
Practice Address - Street 1:6270 MCDONOUGH DR STE G
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1242
Practice Address - Country:US
Practice Address - Phone:770-988-6951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003218582AMedicaid