Provider Demographics
NPI:1932617917
Name:INFINITE LABORATORIES GA LLC
Entity Type:Organization
Organization Name:INFINITE LABORATORIES GA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:615-243-8004
Mailing Address - Street 1:6006 MANCHESTER CIR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-8288
Mailing Address - Country:US
Mailing Address - Phone:615-918-8946
Mailing Address - Fax:
Practice Address - Street 1:4300 PLEASANT HILL RD STE A
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6379
Practice Address - Country:US
Practice Address - Phone:615-243-8004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory