Provider Demographics
NPI:1124890934
Name:OMEGA MOLECULAR LABORATORIES LLC
Entity type:Organization
Organization Name:OMEGA MOLECULAR LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RODRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-686-2134
Mailing Address - Street 1:6445 SHILOH RD STE B
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-8407
Mailing Address - Country:US
Mailing Address - Phone:470-863-6020
Mailing Address - Fax:470-200-2285
Practice Address - Street 1:6445 SHILOH RD STE B
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-8407
Practice Address - Country:US
Practice Address - Phone:470-863-6020
Practice Address - Fax:470-200-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory