Provider Demographics
NPI:1215318076
Name:SOUTHEAST LAB SERVICES, LLC
Entity type:Organization
Organization Name:SOUTHEAST LAB SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-381-1567
Mailing Address - Street 1:270 CARPENTER DR
Mailing Address - Street 2:SUITE 680
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4931
Mailing Address - Country:US
Mailing Address - Phone:404-381-1564
Mailing Address - Fax:
Practice Address - Street 1:270 CARPENTER DRIVE
Practice Address - Street 2:SUITE 680
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:404-381-1564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory