Provider Demographics
NPI:1982101929
Name:GOLGI LABS, LLC
Entity Type:Organization
Organization Name:GOLGI LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DHANUNJAYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GADDAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-294-1826
Mailing Address - Street 1:333 ALCOVY ST STE 4
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2180
Mailing Address - Country:US
Mailing Address - Phone:678-294-1826
Mailing Address - Fax:678-294-1826
Practice Address - Street 1:333 ALCOVY ST STE 4
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2180
Practice Address - Country:US
Practice Address - Phone:678-294-1826
Practice Address - Fax:678-294-1826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11D2146695291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11D2146695OtherCLIA #