Provider Demographics
NPI:1154913028
Name:CEDRUS BIOLABS
Entity type:Organization
Organization Name:CEDRUS BIOLABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIA
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:GATLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:984-201-4167
Mailing Address - Street 1:1922 GRASSY BANKS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-6472
Mailing Address - Country:US
Mailing Address - Phone:984-201-4167
Mailing Address - Fax:
Practice Address - Street 1:1922 GRASSY BANKS DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-6472
Practice Address - Country:US
Practice Address - Phone:984-201-4167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory