Provider Demographics
NPI:1285169359
Name:ENVISION HEALTHCARE RESOURCES, LLC
Entity type:Organization
Organization Name:ENVISION HEALTHCARE RESOURCES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIKELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEBY
Authorized Official - Suffix:
Authorized Official - Credentials:MT(ASCP)
Authorized Official - Phone:678-251-8180
Mailing Address - Street 1:629 AIRPORT RD STE J
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4474
Mailing Address - Country:US
Mailing Address - Phone:678-251-8180
Mailing Address - Fax:770-545-8840
Practice Address - Street 1:629 AIRPORT RD
Practice Address - Street 2:SUITE C
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4474
Practice Address - Country:US
Practice Address - Phone:770-545-8877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-081291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory